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Infinite Variety?

Age cannot wither her, nor custom stale. Her infinite variety.
William Shakespeare

This is not a typical post for me, but something I have been meaning to do to satisfy my own curiosity. I have wondered, how many variations of acupuncture are there? I suspected a lot, but I thought I would go looking and make a list. Since acupuncture is not based in reality but is instead a collection of pseudo-knowledge, there is no reason for acupuncture to have fidelity to fundamental concepts. I suspect in the US that in the future acupuncture will become less heterogenous as schools start teaching to the test that allows for acupuncture licensure.  For now variation rules.

So this will be a list, with description and commentary. If a missed form of acupuncture is noted by others, and I am sure I have,  I will expand the list in an addendum.

  • Chinese Acupuncture. The Grand daddy of acupuncture. Readers of this blog are well aware of the underlying fantasy of meridians and acupoints that comprise classic Chinese acupuncture.

If you are a lumper you could call this one style of acupuncture. If a splitter, it is hard to know how many styles there are. There are variations in the points used, with the number expanding over time and location on the body. There are points on meridians, points off the meridians and points that wander around the body (A-shi points). Even Dong evidently has unique extra-points.

Similarly there are also minor branching meridians off the main qi highway. It seems that any point on the body has the potential to be an acupuncture point, at least as long as it is not on the male genitals.

There is also variability in how the needles are placed and manipulated. It appears that with traditional Chinese acupuncture no one needles the same way

We observed significant differences in rotation amplitude and duration in motion samples among practitioners. GAMM showed marked variations in average regression curves of motion patterns among practitioners.

There is Professor Wu Lian-Zhong‘s technique

which is characterized as soft, flexible, fast, plucking and activating antipathogenic qi.

or that of Professor Li Yan-Fang

hold the needle with the right hand, press gently along the running course of meridians with the left hand to promote qi circulation, hard pressing should be applied at acupoints to disperse the local qi and blood, insert the needle gently and quickly into the subcutaneous region with the right hand, and stop the insertion when patient has the needling sensation. While the fast needling is characterized with shallow insertion and swift manipulation: the left hand of the manipulator should press first along the running course of the meridian, and fix the local skin, hold the needle with the right hand and insert the needle quickly into the acupoint. Withdrawal of the needle should be done immediately after the reinforcing and reducing manipulations.

or the slow needle aka the Eric Clapton technique

From the basic factors of slow needle insertion, the requirements of this manipulation, main points of 4 steps (to straight the needle, to press softly, to twirl the needle and to hold without brute force).

Professor Wu Lian-zhong prefers the four needling method

4 needling methods, oblique needling, horizontal needling, deep needling and transversal needling.

But is countered by professor ZHENG Kui-shan and his innovative needling methods of “warm reinforcing technique” and “cold reducing technique.”

And we cannot forget the stylings of Professor WU Xu’s

The main technique posture is one-hand holding needle with middle finger for pressing, the needle is hold by thumb and index finger, and is assisted by middle finger.

I know how important the middle finger can be in some human interactions.

Perhaps not as elegant not  or as good as Professor Chen Quan-xin’s  proper application of reinforcing-reducing manipulation. There is also the prizing technique although there are those who prefer the twirling reinforcing-reducing method or perhaps  instead the force feedback method.  But I still go with Professor WU Lian-Zhongs

needling technique of ascending the clear and descending the turbid, clinical evidence-based needling technique at special acupoints.

“Ascending the clear and descending the turbid” should have been the motto of the blog.

I suspect that all the variations of how to needle that I found on Pubmed represent a fraction of the variations on the theme of traditional Chinese acupuncture.

In addition to traditional Chinese acupuncture there are also variety of personal schools of acupuncture, all with their own master: Chengjiang acupuncture school, LI Zhi-dao’s “tonifying three qi”acupuncture, regulating marrow sea acupuncture and YAN Ming-guang and XU Feng’s Najia fa, Doctor HUANG Shi-ping’s acupuncture with golden needles, Meihua acupuncture-moxibustion school. These are limited to the hagiographic descriptions on Pubmed; I suspect there are many more but lack the Chinese language skills for deep investigation.

Even the Chinese wonder about the validity of these styles

The expression of DOU Han-qing on “playing a role of meridians, collaterals, qi and blood” is not so accurate, which is suggested to modify as “attaching the importance to needles.” “Theory of heaven, human being and earth” “theory of acupuncture on qi regulation” and “the eight therapeutic methods in treatment of disease” in Jinzhenfu (Ode to Golden Needles) are valuable academically and suggested to be supplemented. The expression of XI Hong on “reinforcing and reducing technique by following or against the running course of meridian” and the expression of XU Feng on “the magic turtle eight techniques” are not concrete. It is required to elaborate them in detail.

Really, what could be more concrete than the magic turtle eight technique? I would have suggested that the magic turtle 8 has a hazy reply try again.

  • All the above could be combined with electricity making electro-acupuncture. Or
  • Laser acupuncture: using lasers instead of needles. Or
  • Acupressure using pressure of the fingers instead of needles.
  • Japanese acupuncture;  which uses thinner needles at less depth with less manipulation. They also have different form of pseudo-diagnosis:

Chinese acupuncturists use the patient’s pulse, tongue, and face to make their diagnosis. Japanese acupuncturists rely more on palpatory findings of the pulse, abdomen, back and meridians. They also look at the tongue, but do so more to tell what’s going on in the stomach and from there make their diagnosis.

So I guess the Chinese are doing it all wrong.

The Japanese also have their subsytems including

  • Hook Needle

    With the unique structure and manipulation techniques of blood-letting and cutting, hook needle serves as a role in dredging meridians, removing blood stasis, purging heat for resuscitation and relaxing synechial tissues. There are three needling techniques of hook needle: swift pricking, bleeding and pricking.

and the painful appearing

directly approaching the intervertebral foramen and interlaminar space with acupuncture needles

and digging out tissues. Ouch.  There is

is similar to a cleaning shower or deep massage on quantum, cell and molecular level.

I do love me my quantum cleansing shower in the morning.  I have a shower box for my cat.  I have yet to open it.  And of course there is

Red hot heated tungsten needles are inserted into the skin for a microsecond and pulled out again.

as well as a one version of which can be used to torture horses.

And we finish up with

The current situation is that acupuncturists have understanding insufficiency in hospital infection management, lack the sterile concepts and consciousness of disinfection and isolation. Aseptic technic principles aren’t strictly followed; disinfection and isolation systems are unsound; sanitary condition of hand of medical staff is unsatisfied.

And last and least, the most ridiculous form, Tong Ren, aka voodoo acupuncture where

the Tong Ren practitioner uses a small human anatomical model as an energetic representation of the patient, tapping on targeted points on the model with a lightweight magnetic hammer.

Really. Not a joke. Watch a video but not, I repeat NOT, with liquids in your mouth.

I am saddened to note that there is no beer acupuncture, although that may represent an opportunity for someone with fewer scruples than I.

So lets see. All told that’s a minimum of 32 styles if a lumper, double or triple if you want to add electricity or lasers to an existing style. More if you add a particular style of needle manipulation. All equally valid and equally efficacious, right?  So many permutations on a theme of pseudo-knowledge.

Dr. Novella refers to acupuncture as theatrical placebo.  It would appear to be a multitude of one act plays, all farce.

Posted in: Acupuncture

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“Quackery: A $10 Billion Scandal”

Rubber ducky
Who would you guess authored a 250-page report which begins with this Preface?

This report marks the culmination of an intensive four-year review of quackery and its impact on the elderly. . . As this report details, quackery has traveled far from the day of the pitchman and covered wagon to emerge as big business. Those who orchestrate and profit from the sale and promotion of these useless and often harmful “health” products are no longer quaint and comical figures. They are well organized, sophisticated and persistent. [We estimate] the cost of quackery – the promotion and sale of useless remedies promising relief from chronic and critical health conditions – exceeds $10 billion a year. The costs of quackery in human terms, measured in disillusion, pain, relief forsaken or postponed because of reliance on unproven methods, is more difficult to measure, but nonetheless real. All too frequently, the purchaser has paid with his life. While the impact of quackery on our lives has been increasing and growing in sophistication, public and private efforts designed to address and control this problem have diminished, been redirected or disbanded.

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Posted in: Acupuncture, Cancer, Diagnostic tests & procedures, Health Fraud, Herbs & Supplements, Politics and Regulation

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SBM on Wikipedia in Every Language

Four websites smallOne of the most interesting aspects of living through the second half of the 20th century and into the first half of the 21st century is the profound change in access to information. I remember in the 1980s there was a buzz (at least among technophiles and science fiction nerds) about how computers were going to be connected in a worldwide network and it would transform the way we access information and communicate. The reality we are living in now exceeds even the most fevered predictions being made at that time.

What was difficult to anticipate was how rapid access to almost any information would affect our day-to-day lives. Now, during a discussion, if a fact is in dispute we can simply look it up and resolve the dispute. I can no longer imagine doing research in a pre-internet age, promoting science-based medicine without social media, or collaborating without the virtual-time communication of e-mail.

The internet is rapidly becoming humanity’s collective culture and body of knowledge. For that reason it is important to nurture that body of knowledge to ensure that it is complete, accurate, and fair. That goal is frustrated, however, by the fact that the World Wide Web is not simply being used for scholarly information. It is also a tool to promote ideology and commercial interests. Therefore any efforts to provide scientifically accurate and unbiased information are likely to be swamped by well-funded and highly-motivated misinformation. Search on any medical topic and you will quickly see what I mean.

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Posted in: Science and Medicine

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Salk’s swansong: renaissance of the injected polio vaccine

Picture a lab scientist. White coat, pensive expression, microscope in hand. Glasses, perhaps. The person you have in mind (providing you are willing to humour a stereotype or two) may have a striking resemblance to Jonas Salk, the archetypal laboratory researcher, born in New York City on Wednesday 28th October 1914 — one hundred years ago today.

The name will be familiar to many. As creator of the inactivated polio vaccine (or IPV), Salk is cemented firmly into the annals of medical history. When his vaccine hit the shelves in 1955, the annual epidemics of poliomyelitis represented a fierce insult to postwar American civility: one particularly devastating bout in 1952 caused over 20,000 cases of paralysis and more than 3,000 deaths, mostly among children. The arrival of IPV was greeted with nationwide celebrations, and Salk was praised as a worker of miracles.

Jonas Salk at the University of Pittsburgh where he developed the first polio vaccine.

Jonas Salk at the University of Pittsburgh where he developed the first polio vaccine.

IPV has been in demand ever since, and its use in several countries has been sufficient to get rid of polio. Until recently, however, Salk’s injected vaccine has largely played second fiddle in eradication efforts. When the Global Polio Eradication Initiative was launched in 1988, it favoured an alternative formulation, Albert Sabin’s oral polio vaccine (OPV), as its weapon of choice.

But the spotlight may be shifting. With the eradication programme preparing for what is hoped to be a final onslaught, IPV is poised to take centre stage once more. Indeed, the World Health Organization recently recommended that all countries introduce at least one dose of Salk’s vaccine into routine immunisation by the end of 2015.

Why is IPV so important to polio eradication plans? What does the injected vaccine offer that the oral one does not? The centenary of Salk’s birth offers a fitting occasion to consider these issues.

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Posted in: History, Public Health, Vaccines

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Mirror Neurons and the Pitfalls of Brain Research

myth of mirror neurons

[Ed. Note: I realize that I normally post on Monday, but thanks to an R21 grant deadline tomorrow, I will not be able to post new material today (although you might have noticed some "familiar" material posted yesterday.) Harriet has graciously agreed to cover for me today, and we have a special guest post for you tomorrow. Fear not. I'll soon be back. Trying to get the lab funded takes momentary precedence.]

In his new book The Myth of Mirror Neurons: The Real Neuroscience of Communication and Cognition , Gregory Hickok, a professor of cognitive science, challenges current conceptions about mirror neurons. He shows how a complex mythology arose and why it is unwarranted, how experimental results were misinterpreted and disconfirming evidence ignored, and how other interpretations might lead to better insights about how the brain works.

I couldn’t say it any better than Steven Pinker did on the jacket blurb:

Every now and again an idea from science escapes from the lab and takes on a life of its own as an explanation for all mysteries, a validation of our deepest yearnings, and irresistible bait for journalists and humanities scholars…Hickok puts an end to this monkey business by showing that mirror neurons do not, in fact, explain language, empathy, society, and world peace. But this is not a negative exposé—the reader of this book will learn a great deal of the contemporary sciences of language, mind, and brain, and will find that the reality is more exciting than the mythology. (more…)

Posted in: Book & movie reviews, Neuroscience/Mental Health

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A little shameless self-promotion and a plea

Here’s a little shameless self-promotion, which we editors at Science-Based Medicine indulge in from time to time. This time around, I’d just like to mention that I’m the guest on the latest episode of the Skeptics’ Guide to the Universe, where I was permitted to pontificate about children with cancer whose parents deny them chemotherapy. Check it out.

Second, in less than four weeks, I will be giving a talk at Skepticon. The great thing about Skepticon is that it’s free, but that requires donations. So, as a speaker, I’m going to ask you all once again to give until it hurts.

Posted in: Announcements

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Brian Hooker and Andrew Wakefield accuse the CDC of scientific fraud. Irony meters everywhere explode.

conspiracy-theories-everywhere

The antivaccine movement and conspiracy theories go together like beer and Buffalo wings, except that neither are as good as, yes, beer and Buffalo wings. (Maybe it’s more like manure and compost.) In any case, the antivaccine movement is rife with conspiracy theories. I’ve heard and written about more than I can remember right now, and I’m under no illusion that I’ve heard anywhere near all of them. Indeed, it seems that every month I see a new one.

There is, however, a granddaddy of conspiracy theories among antivaccinationists, or, as it’s been called, the central conspiracy theory of the antivaccine movement. That conspiracy theory postulates that “they” (in the U.S, the CDC) have known for a long time that vaccines cause autism, but “they” are covering it up. In other words, the CDC has, according to this conspiracy theory, been intentionally hiding and suppressing evidence that antivaccinationists were right all along and vaccines do cause autism. Never mind what the science really says (that vaccines do work don’t cause autism)! To the antivaccine contingent, that science is “fraudulent” and the CDC knew it! Why do you think that the antivaccine movement, in particular Robert F. Kennedy, Jr., went full mental jacket when Poul Thorsen was accused of financial shenanigans (i.e., fraud) with grant money from the federal government? It was a perfect story to distract from the inconvenient lack of science supporting the antivaccine view that vaccines cause autism. More importantly, from the antivaccine standpoint, it was seen as “validation” that the CDC studies failing to find a link between autism and vaccines were either fraudulent or incompetently performed. Why? Because Thorsen was co-investigator on a couple of the key studies that failed to find a link between the MMR and autism, antivaccinationists thought that his apparent financial fraud must mean that he committed scientific fraud. They’re the same thing, right? Well, not really. There were a lot of co-investigators, and Thorsen was only a middle author on those studies.
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Posted in: Neuroscience/Mental Health, Public Health, Vaccines

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The “It’s All Good!” Fallacy of Complementary and Alternative Medicine…..

usedcars-01

“Trust me, have I got a deal for you!”

As a young mother comforts her feverish and uncomfortable infant, a doctor enters the dimly-lit exam room. The child’s mother and the bedside nurse look at him expectantly.

“I’ve got the results. There is an infection in your son’s spinal fluid, which was one of the things we discussed as a possible cause of his high fever and irritability,” the physician explains to the now-crying mother. “We need to start treatment right away and admit him to the hospital.”

After answering the distraught mother’s questions and discussing her child’s treatment plan, the doctor leaves the room and begins to write orders in the patient’s chart. The nurse, eager to begin appropriate therapy looks over his shoulder with a confused look on his face.

“Excuse me doc, but you’ve got to be a little more clear on that order don’t you think?”

Written in barely-legible doctor scribble, next to the date and time of the encounter and above his signature and hospital number, is the lone word “antibiotics”.

“What do you mean? This child is sick and he needs antibiotics stat!”

“Sure doc, but which one, how much and how often? Where did you go to medical school again?”

“Clearly you aren’t current on the literature. Antibiotics have been around for decades and have been proven time and time again to treat infections. Millions of people take them every day and are pleased with the results. Now you are wasting precious time that could be spent caring for this sick child!”

The nurse, unhappy with the response, storms off to find assistance from his supervisor. The doctor, confident that he is providing competent medical are for his patient, expresses dismay at how closed-minded some of his colleagues are.

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Posted in: Science and Medicine

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Lessons from the dubious rise and inevitable fall of green coffee beans

Green-Coffee-Bean-BOGUS

News this week that a randomized controlled trial of green coffee bean (GCB) has been officially retracted from the medical literature signals what is hopefully the end to one of the most questionable diet products to appear on the market in years. Plucked from obscurity and then subjected to bogus research, it’s now clear that the only people that actually benefited from GCB were those that profited from its sale. GCB had some powerful boosters, too. Once it became one of Dr. Oz’s “miracle” weight loss cures, sales exploded following two hype-filled episodes. Oz even did a made-for TV clinical trial with GCB, ignoring the requirements for researchers to obtain ethical approvals before conducting human subject research. Oz’s promotion of GCB was so breathless and detached from the actual evidence that his actions were subsequently eviscerated by Senator Clair McCaskill during televised hearings on weight loss scams. It’s a long, sordid, ugly and yet entirely predictable story. (more…)

Posted in: Clinical Trials, Health Fraud, Herbs & Supplements, Science and the Media

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A TCM Challenge

ah-bao-01In the tradition of James Randi, a Chinese doctor who is an outspoken critic of Traditional Chinese Medicine (TCM) has issued a challenge to its proponents. He has put up 50,000 yuan (about $8,000), which has been matched by donors for a total of over 100,000 yuan, to any TCM practitioner who can use pulse diagnosis to determine with accuracy whether females subjects are pregnant.

Ah Bao is the blogging pseudonym of a burn-care doctor at Beijing Jishuitan hospital. He is trained in scientific medicine and has criticized his country for clinging to pre-scientific philosophy-based health care. He calls TCM “fake science” and now wants to demonstrate that the claims of TCM practitioners are without factual basis.

His challenge is a good one because it focuses on a clear criterion. Subjects will either be pregnant or not pregnant, and the TCM practitioner, using only pulse analysis and blinded to the patient themselves, must determine with an 80% accuracy which subjects are pregnant. A TCM practitioner, Zhen Yang, has taken him up on the challenge and they are now working out the details. (more…)

Posted in: Traditional Chinese Medicine

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