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Acupuncture is astrology with needles

EDITOR’S NOTE: Because, for the first time in a year and a half, both professional and personal responsibilities precluded my producing a post for Science-Based Medicine, today is the perfect time to present a guest post by Ben Kavoussi. Ben is a medical informatician with an interest in the scientific evaluation of CAM, as well as a Captain in the Army Medical Service Corps. He also studied to become an acupuncturist himself, and his article is a fascinating look at some little known history behind acupuncture that strongly suggests that it is more akin to astrology than you may be aware of. Certainly I had been unaware of it, and I bet most of our readers are unaware of it, too.

Enjoy!

I’ll be back with a post here next week at the latest.

Acupuncture is astrology with needles

by Ben Kavoussi, MS, MSOM, LAc

The following is an excerpt of an upcoming article called “The Untold Story of Acupuncture.” It is scheduled to be published in December 2009 in Focus in Alternative and Complementary Therapies (FACT), a review journal that presents the evidence on alternative medicine in an analytic and impartial manner. It argues that if the effects of “real” and “sham” acupuncture do not significantly differ in well-conducted trials, it is because traditional theories for selecting points and means of stimulation are not based on an empirical rationale, but on ancient cosmology, astrology and mythology. These theories significantly resemble those that underlined European and Islamic astrological medicine and bloodletting in the Middle-Ages. In addition, the alleged predominance of acupuncture amongst the scholarly medical traditions of China is not supported by evidence, given that for most of China’s long medical history, needling, bloodletting and cautery were largely practiced by itinerant and illiterate folk-healers, and frowned upon by the learned physicians who favored the use of pharmacopoeia.

Heaven is covered with constellations, Earth with waterways, and man with channels.

Yellow Emperor’s Canon of Medicine (黄帝内经, huang di nei jing)1

Acupuncture is presumed to have its origins in blood ritual, magic tattooing and body piercing associated with Neolithic healing practices.2,3 The Neolithic origin hypothesis is supported by the presence of nonfigurative tattoos on the Tyrolean Ice Man–an inhabitant of the Oetztal Alps in Europe–whose naturally preserved 5,200-year-old body displays a set of small cross-shaped tattoos that are located significantly proximal to classical acupuncture points. Medical imaging shows that the middle-aged man suffered from lumbar arthrosis and the cross-shaped tattoos are located at points traditionally indicated for this condition.4,5 Similar nonfigurative tattoos and evidence of therapeutic tattooing, lancing and blood ritual have been found throughout the Ancient world, including the Americas.6,7,8 Health-related tattoos are still prevalent in Tibet, where specific points on the body are needled with a blend of medicinal herbs in the dyes. These practices appear to be largely intended to maintain balance with the natural and spiritual worlds, and also to protect against demonic infestation and malevolence. Seemingly, this Neolithic and Bronze Age lancing heritage, which was intertwined with magic and animism, has evolved in various cultures into codified systems of lancing and venesection for assuring good health and longevity. In addition to treating the impurity or superabundance of blood, in various cultures lancing was also believed to affect the flow of a numinous life-force that is, for instance, called qi (or chi, 氣, pronounced “chee”) in Chinese, prāna (प्राण) in Sanskrit, pneuma (πνεύμα) in Greek, etc.9 In many instances, elements of metaphysics, mythology, mysticism, magic, shamanism, exorcism, astrology and empirical medicine intimately intertwined, making it difficult for modern scholars to interpret them as mutually exclusive categories.

In China, for instance, the numinous force was believed to mirror the Sun’s annual journey through the Ecliptic–meaning its apparent path on the celestial sphere–and to circulate in a network of 12 primary jing luo (經络) known in English as the chinglo channels or simply channels or meridians (a term coined in 1939 by George Soulié de Morant, a French diplomat). These imaginary pathways run from head to toes and interconnect around 360 primary points on the skin.10 There is a strong possibility that the web of these channels was a rudimentary model of the vascular system that was conceptualized according to an episteme­–meaning a set of fundamental beliefs–that was based on astrological principles and mythology. This episteme­ also indicated that a person’s health and destiny are determined by the position of the Sun, the Moon, the 5 Planets and the apparition of comets, along with the person’s time of birth.11 In this worldview, each body segment corresponds to one of the 12 Houses of the Chinese zodiac system di zhi (地支) known in English as the Earthly Branches, and which consists of 12 two-hour (30°) divisions of the Ecliptic. The channels are therefore named according to their degree of yin (阴) and yang (阳), from tai yang (太阳) to jue yin (厥阴), which are terms that describe the phases and the positions of the Sun and the Moon.12 Each has five special points designated by the characters 水 (Water), 木 (Wood), 火 (Fire), 土 (Earth) and 金 (Metal) which are also the Chinese terms for Mercury, Jupiter, Mars, Saturn and Venus,13 and seem to correspond to the transit positions of these Planets in the matching House. Each point is also associated with a color, which comes from the visual appearance of the matching Planet in the night sky. Venus is white, Jupiter blue-green, Saturn golden-yellow, Mars red, and Mercury “black,” for it appears to be the dimmest of the five. Each of these points has also an occult connection with a direction, a segment of time, a season, a number set, a taste, a musical note, an internal organ, a body region, etc, in an ancient Chinese metaphysical cosmology often referred to as “correlative cosmology”14 and reminiscent of the esoteric and mystical beliefs held by Pythagoras of Samos (c. 580-c. 490 BC) and his followers, the Pythagoreans.15 In his occult and magico-mystical worldview, the nature of the life-force qi is often described in such terms:16

The major premise of Chinese medical theory is that all the forms of life in the universe are animated by an essential life-force or vital energy called qi. Qi also means “breath” and air and is similar to the Hindu concept of prāna. Invisible, tasteless, odorless, and formless, qi nevertheless permeates the entire cosmos. Qi is transferable and transmutable; digestion extracts qi from food and drink and transfers it to the body, breathing extracts qi from air and transfers it to the lungs. When these two forms of qi meet in the blood-stream, they transmute to form human-qi, which then circulates throughout the body as vital energy. It is the quality and balance of your qi that determines your state of health and span of life.

Other texts refer to qi as a “cosmic spirit that pervades and enlivens all things”17 and “from which the world was created.”18 For instance, the alchemist Ko Hung (葛洪, 2nd – 3rd Century AD) writes that “Man is in qi and qi is in each human being. Heaven and Earth and the ten thousand things all require qi to stay alive. A person that knows how to allow qi to circulate will preserve himself and banish illness that might cause him harm.”19,20 The belief in a “cosmological correlation” between its pathways in the body and the Houses of the Chinese zodiac seems to be based on health and safety beliefs in geocentric cosmology and the related doctrine of “as above, so below” which stipulated that everything in the Heavens has its counterpart on Earth and also in man.

The episteme of “as above, so below” and correlative cosmology were prevalent throughout the ancient world, from the Eastern Mediterranean cultures to Northern Europe. It is notably found in the relics of a collection of occult writings called the Corpus Hermetica which are believed to be compiled in Hellenistic Egypt during the 1st or 3rd century AD and are attributed to Hermes Trismegistus (“Thrice-great Hermes”), the Greek equivalent of the Egyptian god of wisdom, Thoth. The original text was presumably lost or destroyed during the systematic annihilation of non-Christian literature between the 4th and 6th centuries AD. Nonetheless, a section of it known as the Emerald Tablet survived and was translated into Arabic by the Muslim conquerors and later into Latin by John of Seville c. 1140 AD and by Philip of Tripoli c. 1243 AD. An Arabic version of the Tablet by the Muslim polymath and alchemist Abu Musa Jābir ibn Hayyān (أبو موسى جابر بن حيان, c. 721-c. 815 AD) states “That which is above is from that which is below, and that which is below is from that which is above, working the miracles of One.”21 Given the prevalence of this set of fundamental beliefs throughout the ancient world, it seems that the natural philosophy that has given rise to the underlying theories of acupuncture in China stems from the same set of beliefs in that were also prevalent along the Silk Road in Persia, Mesopotamia, Egypt and in Greece and that have influenced the health and safety beliefs of pre-Christian Europe, such as the Eastern Mediterranean mystery cults,22 such as Mithraic Mysteries.23 This hypothesis is supported by a statement by Gregor (Gregorius) Reisch (c. 1467-1525) in Margarita Philosophica (Pearl of Wisdom), first published in 1503:24

The pagans believed that the zodiac formed the body of the Grand Man of the Universe. This body, which they called the Macrocosm (the Great World), was divided into twelve major parts, one of which was under the control of the celestial powers reposing in each of the zodiacal constellations. Believing that the entire universal system was epitomized in man’s body, which they called the Microcosm (the Little World), they evolved that now familiar figure of “the cut-up man in the almanac” by allotting a sign of the zodiac to each of twelve major parts of the human body.

Figure1

Figure 1: European medieval Zodiac Man form John de Foxton’s Liber Cosmographiae, published in 1408. It indicated the repartition of astrological influences on the body which physicians used to determine the auspicious time to let blood. Images courtesy of The Master and Fellows of Trinity College, Cambridge, UK.

Given this fundamental belief, European physicians until the 17th century based the practice of medicine on celestial computations, also known as Iatromathematics, astrological medicine or astromedicine. They therefore utilized planetary transition tables called ephemerides or Alfonsine tables to cast a prognostication–meaning a disease outcome prediction based on astrological conjunctions, alignments and the angle between Planets (Aspects)–prior to perform venesection, cupping, cautery, surgery or to prescribe medicines with specific astral powers.25 Disease was then believed to result from interruptions to the flow of the numinous life-force pneuma and an imbalance in the four humors–blood, yellow bile, black bile and phlegm–which were each associated to an element, a planet, a color, etc, according to European correlative cosmology. Therapy consisted of purging the offending humor and its noxious pressures during favorable Aspects. Most bloodletters would open a vein in the arm, leg or neck with a fine knife called a “lancet.” They would tie off the area with a tourniquet and hold the lancet delicately between thumb and forefinger and strike diagonally or lengthwise into the vein to avoid severing it. They would then collect the blood in a measuring bowl.26 Initially, according to the classical Greek procedure, blood was let from a site near the location of the illness but later physicians drew a smaller amount of blood from a distant site. This procedure not only required the knowledge of the distal cutting points and the precise amount of blood to draw, but also the knowledge of ephemerides to establish the suitable Aspects and timing. Medieval medical manuscripts therefore contained ephemeris charts (volvelles) and the schematic of a body covered with astrological signs, generally known as “Zodiac Man,” which illustrated the specific influences of astrological signs on body parts and organs (Figure 1) and the location of the associated bloodletting points (Figure 2).

Figure2

Figure 2: European Bloodletting Man from Hans von Gersdorff’s Feldtbüch der Wundartzney, published in 1528. Bloodletting was done by venesection or the application of leeches. Most of these points correspond to key acupuncture points, such as LV3, UB40, SI3, LI4, LI11, SJ3, LU5, etc. Image courtesy of the National Library of Medicine, US.

The allotment of the zodiacs to each of the major parts of the body started at the head with Ares and ran down to the feet, which belonged to Pisces. Cancer was believed to be responsible for diseases of the lungs and the eyes and Scorpio the genital afflictions, for instance.27 The practice of lancing, bloodletting and cupping (الحجامة, hijama) to affect specific organs or to mitigate specific diseases based on a postulated relationship between the internal organs and points on the surface of the skin is still prevalent amongst the Muslims worldwide and nowadays video instructions for it are available, even on YouTube. It is plausible that the same principle is at the origin of acupuncture channels in China28 because the distribution of the regions of astrological influences and the related venesection points portrayed in medieval Islamic and European manuscripts significantly resembles the allocation of master, command, influential, and other key points (Table 1). It is important to note that Greco-Arabic bloodletting was known in China and fragments of Avicenna’s (c. 980 – 1037) The Canon of Medicine (الطب في القانون) were translated during the time of the Yuan dynasty (1271-1368) and published along with other Persian and Arabic texts in the Hui Hui Yao Fang (回回藥方)–meaning the Prescriptions of the Hui Nation–with much of the text in Arabic.29 The correlation between Chinese acupuncture and bloodletting is further supported by the fact that the Chinese character zhēn (針) etymologically refers to lancing with coarse needles or any sharp object used for scarification, bloodletting and minor surgery.30 In addition, As Paul Unschuld points out, the opening of superficial or deep-lying vessels for bloodletting seems to predate the manipulation of qi with needles.31 However, Linda Barnes, in her fascinating book on how China, the Chinese, and their healing practices were imagined in the West from the late Middle Ages through to the mid-19th Century, also argues that there were “sufficient apparent similarities that an early observer might have been excused for imagining that the Chinese and European practices grew from the same conceptual framework.”32 Although she seems to agree with Paul Unschuld’s assessment that acupuncture emerged as an offshoot of bloodletting, she also notes that the early European observers seem to have misunderstood the ways in which the body itself was conceptualized by the Chinese, and assumed that they were simply using a version inferior of the Greek humoral system, and routinely failed to recognize or value an alternate conceptual universe which, in the long run, made it easier for them to dismiss Chinese understandings of the human body.

Western Zodiacs

Degrees

Regions – Organs

 

Chinese Zodiacs

Hours

Meridians - Organs

Aries 0°-30° Head   Tiger 3AM-5AM Lung
Taurus 30°-60° Neck , throat   Rabbit 5AM-7AM Large Intestine
Gemini 60°-90° Lungs, arms, shoulders   Dragon 7AM-9 AM Stomach
Cancer 90°-120° Chest, breasts, stomach   Snake 9AM-11AM Spleen
Leo 120°-150° Heart, upper back   Horse 11AM-1PM Heart
Virgo 150°-180° Abdomen, digestive system   Sheep 1PM-3PM Small Intestine
Libra 180°-210° Kidneys, lumbar region   Monkey 3PM-5PM Bladder
Scorpio 210°-240° Genitals   Rooster 5PM-7PM Kidney
Sagittarius 240°-270° Hips, thighs   Dog 7PM-9PM Pericardium
Capricorn 270°-300° Knees, bones   Pig 9PM-11PM San Jiao
Aquarius 300°-330° Calves, shins, ankles   Rat 11PM-1AM Gallbladder
Pisces 330°-360° Feet   Ox 1AM-3AM Liver

Table 1: Similarities between Muslim and medieval astromedicine and traditional acupuncture theory. For instance, LU7, a point on the Lung meridian is the command point of the head and the neck; LI4, an important point on the Large Intestine meridian controls the face and the throat; SP4 on the Spleen meridian is used for the diseases of the chest, breast and the stomach. The Kidney meridian controls the genitals; an important point related to San Jiao (UB39) is found on the knee; one related to Gallbladder (GB40) on the ankle; and the most important points of the Liver meridian, LV2-3 are on the feet, etc.33 Note that a two-hour segment is the same time measure as 30°, for the celestial sphere moves by 15° every hour.

Paradoxically, for most of China’s long medical history, lancing, bloodletting, acupuncture and surgery were practiced by itinerant folk-healers and considered a lower class of therapy compared to the use of pharmacopoeia. As the historian Bridie Andrews Minehan describes:34

The lowly acupuncturists engaged in a great deal of minor surgery, and the two specialties of acupuncture (zhenjiu) and external medicine or surgery (waike) overlapped considerably. Illustrations of the nine needles of acupuncture, featured in many handbooks from the late imperial period, depicted scalpel-like knives, cautery irons, and three-edged bodkins for bloodletting and lancing boils, as well as the fine needles we currently associate with acupuncture.

Andrews Minehan also notes that although needling is often cited in the Yellow Emperor’s Canon of Medicine, throughout the history of China relatively little has been written on it elsewhere. Reportedly, by the middle of the second millennium its practice was mostly abandoned, and eventually the Chinese and other Eastern societies took steps to eliminate it altogether.34,35 In 1822 an edict banned its teaching and practice from the Imperial Medical Academy, the institution that provided physicians to the Court. The Japanese government equally prohibited the practice in 1876.36 The final step in China took place in 1929 when it was literally outlawed.37 However, in the early 1930s a Chinese pediatrician by the name of Cheng Dan’an (承淡安, 1899-1957) proposed that needling therapy should be resurrected because its actions could potentially be explained by neurology. He therefore repositioned the points towards nerve pathways and away from blood vessels-where they were previously used for bloodletting. His reform also included replacing coarse needles with the filiform ones in use today.38 Reformed acupuncture gained further interest through the revolutionary committees in the People’s Republic of China in the 1950s and 1960s along with a careful selection of other traditional, folkloric and empirical modalities that were added to scientific medicine to create a makeshift medical system that could meet the dire public health and political needs of Maoist China while fitting the principles of Marxist dialectics. In deconstructing the events of that period, Kim Taylor in her remarkable book on Chinese medicine in early communist China, explains that this makeshift system has achieved the scale of promotion it did because it fitted in, sometimes in an almost accidental fashion, with the ideals of the Communist Revolution. As a result, by the 1960s acupuncture had passed from a marginal practice to an essential and high-profile part of the national health-care system under the Chinese Communist Party, who, as Kim Taylor argues, had laid the foundation for the institutionalized and standardized format of modern Chinese medicine and acupuncture found in China and abroad today.39 This modern construct was also a part of the training of the “barefoot doctors,” meaning peasants with an intensive three- to six-month medical and paramedical training, who worked in rural areas during the nationwide healthcare disarray of the Cultural Revolution era.40 They provided basic health care, immunizations, birth control and health education, and organized sanitation campaigns. Chairman Mao believed, however, that ancient natural philosophies that underlined these therapies represented a spontaneous and naive dialectical worldview based on social and historical conditions of their time and should be replaced by modern science.41 It is also reported that he did not use acupuncture and Chinese medicine for his own ailments.42

It is the reformed and “sanitized” acupuncture and the makeshift theoretical framework of Maoist China that have flourished in the West as “Traditional,” “Chinese,” “Oriental,” and most recently as “Asian” medicine. Nowadays, in every major metropolitan area in the US and in Europe, one can find acupuncture boutiques where practitioners inaccurately claim that gently puncturing the skin with silicon-coated stainless-steel filiform needles is a scholarly medical tradition of ancient China that has been used for over 2,000 years to relieve pain and to treat a variety of diseases. Meanwhile and despite what is reported by the advocates, this gentle insertion of fine needles at specific points on the skin has consistently failed in well-conducted trials to show compelling evidence of efficacy for conditions that are amenable to specific treatments.43,44 And whatever the clinical efficacy of any type of needling therapy, there is still no convincing evidence that meridians exist as discrete entities distinct from blood vessels.45

ADDENDUM:

My sincerest apologies to Linda Barnes for citing her work as simply arguing that there are sufficient similarities between needling in China and bloodletting in Europe to warrant the belief that both practices grew from the same conceptual framework. Indeed, the full citation is substantially more nuanced and complex, and corrections were made to reflect her full argument. I appreciate her bringing this to my attention.

REFERENCES:

  1. Veith I (Translator). The Yellow Emperor’s Classic of Internal Medicine. University of California Press, 1st edition. 2002.
  2. Ernst E. Acupuncture – a critical analysis. J Intern Med. 2006; 259(2):125-137.
  3. Ramey D, Buell PD. A true history of acupuncture. Focus Altern Complement Ther. 2004;9:269-273.
  4. Dorfer L, Moser M, Spindler K, Bahr F, Egarter-Vigl E, Dohr G. 5200-year-old acupuncture in central Europe? Science. 1998;282(5387):242-243.
  5. Dorfer L, Moser M, Bahr F, et al. A medical report from the Stone Age? Lancet. 1999;354:1023-1025.
  6. Smith, GS, Zimmerman R. Tattooing Found on a 1600 Year Old Frozen, Mummified Body from St. Lawrence Island, Alaska. American Antiquity 40(4): 433-437. 1975.
  7. Garcia, Hernan and Antonio, Sierra. Wind in the Blood – Mayan Healing & Chinese Medicine. Redwing Books, 1999.
  8. Villoldo A. Shaman, Healer, Sage. Hamony Books, 2000.
  9. Lao Tzu (Author), Mair VH (Translator). Tao Te Ching: The Classic Book of Integrity and the Way. New York. Bantam Books. 1990.
  10. Whorton JC. Nature Cures: The History of Alternative Medicine in America. Oxford University Press, 2004.
  11. Wu AS. Chinese Astrology. The Career Press, Inc. 2005.
  12. Lo V. The territory between life and death. Essay review. Med Hist. 2003 Apr;47(2):250-8.
  13. Walters D. Chinese Astrology. Aquarian Press. 1987.
  14. Pregadio F. Great Clarity: Daoism and Alchemy in Early Medieval China. Stanford University Press, 1st edition. 2006.
  15. Burkert W. Lore and Science in Ancient Pythagoreanism. Harvard University Press, Cambridge, MA. 1972.
  16. Reid D. Chinese Herbal Medicine. Shambhala. 1987.
  17. Pas JF. Historical Dictionary of Taoism. The Scarecrow Press, Inc. 1998.
  18. Religion of Tao. Center of Traditional Taoist Studies. www.tao.org. Accessed September 2008.
  19. Fischer-Schreiber I. The Shambhala Dictionary of Taoism. Shambhala. 1st edition. 1996.
  20. Ware J. Alchemy, Medicine and Religion in the China of A.D. 320. The Nei P’ien of Ko Hung (Pao-p’u tzu). Cambridge (Mass.): M.I.T. Press, 1966. Reprint. New York: Dover Publications, 1981.
  21. Holmyard EJ (editor) The Arabic Works of Jabir ibn Hayyan. New York, E. P. Dutton. 1928.
  22. Kingsley P. Ancient Philosophy, Mystery, and Magic: Empedocles and Pythagorean Tradition. Oxford University Press. 1997.
  23. Copenhaver, BP (Editor). Hermetica: The Greek Corpus Hermeticum and the Latin Asclepius in a New English Translation, with Notes and Introduction. Cambridge. 1992.
  24. Reisch G. Margarita Philosophica, Hoc Est Habituum Sev Disciplinarum Omnium. Basileæ 1583.
  25. Jackson WA. A Short Guide to Humoral Medicine. Trends Pharmacol Sci. 2001 Sep;22(9):487-9.
  26. Starr D. Blood: An Epic History of Medicine and Commerce. Knopf. 1st edition. 1998.
  27. Manilius M (author), Goold GP (Translator). Manilius: Astronomica. Harvard University Press. 1977.
  28. Epler DC Jr. Bloodletting in early Chinese medicine and its relation to the origin of acupuncture. Bull Hist Med. 1980 Fall;54(3):337-67.
  29. Alpher JV (Editor) Oriental Medicine: An Illustrated Guide to the Asian Arts of Healing. Serindia. United Kingdom, 1st Edition 1995.
  30. Hall H. Puncturing the Acupuncture Myth. Science-Based Medicine. Posted on October 21, 2008. Accessed November 2008. http://www.sciencebasedmedicine.org/?p=252.
  31. Unschuld PU. Medicine in China: A History of Ideas. University of California Press. 1988.
  32. Barnes LL. Needles, Herbs, Gods, and Ghosts: China, Healing, and the West to 1848. Harvard University Press. 2005.
  33. Kim HB. Handbook of Oriental Medicine. Harmony & Balance Press; 3rd Edition. 2007.
  34. Andrews BJ. History of Pain: Acupuncture and the Reinvention of Chinese Medicine. APS Bulletin. May/June 1999;9(3). 5.
  35. Unschuld PU: The past 1000 years of Chinese medicine. Lancet Suppl SIV9:354, 1999.
  36. Skrbanek P: Acupuncture: Past, present and future, in Stalker D, Glymour C (editors): Examining Holistic Medicine. Buffalo, NY, Prometheus Books. 1985.
  37. Ma KW. The roots and development of Chinese acupuncture: from prehistory to early 20th century. Acupunct Med 1992;10(Suppl):92-9.
  38. Andrews B. Tailoring Tradition: The Impact of Modern Medicine on Traditional Chinese Medicine, 1887-1937. In Alleton V and Volkov A (editors). Notions et Percpetions du Changement et Chine. Paris: Collège de France, Institut des Hautes Études Chinoises. 1994
  39. Taylor K. Chinese Medicine in Early Communist China, 1945-63; A Medicine of Revolution, RoutledgeCurzon, 2005.
  40. Scheid V. Chinese Medicine in Contemporary China: Plurality and Synthesis. Duke University Press, 2002.
  41. Schram SR. The Political Thought of Mao Tse-Tung. New York: Praeger Publishers. 1969.
  42. Basser S. Acupuncture: a history. Sci Rev Altern Med 1999;3:34-41.
  43. Ernst E, White A, eds. Acupuncture: A Scientific Appraisal. Oxford, UK: Butterworth-Heinemann. 1999.
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  45. Ernst E. Complementary medicine: the facts. Phys Ther Rev 1997;2:49-57.

Posted in: Acupuncture, History

Leave a Comment (30) ↓

30 thoughts on “Acupuncture is astrology with needles

  1. With all due respect to Kimball Atwood and Hariett Hall, this is probably the most interesting article on the origins of acupuncture I have ever read.

    (And the posts by Dr.’s Atwood and Hall were VERY interesting).

  2. Michelle B says:

    I am with Karl. This article is just scrumptious–a delicious blend of everything tasty. (All right, All right, I have been baking today!)

  3. Versus says:

    Impressive! This research should prove useful the next time a state legislature is pressed to adopt an acupuncture practice act. How wonderfully ironic that the venerated “Traditional Chinese Medicine” turns out to be bloodletting’s first cousin, steeped in astrology, and Communist to boot.

  4. Zetetic says:

    I’ll definitely keep this as a reference! I am continually astounded by apparently intelligent people who subscribe to all manner of alt-med. At a recent dinner party with people I am loosely acquainted with through a civic cultural foundation, I was surrounded by a mostly graduate educated group who frequent naturopaths, chiropractors and acupuncturists. Anecdotal testimonials flowed like a raging river and I received wide eyed glares when I debunked virtually everything said. It’s been related many times on this web site that confrontation with these “true-believers” is akin to insulting their religion our cultural group. I am almost uncontrollably compelled to relate science based medicine and it’s often difficult to always be socially correct.

  5. David Gorski says:

    It’s been related many times on this web site that confrontation with these “true-believers” is akin to insulting their religion our cultural group.

    That’s because it is.

  6. tommyhj says:

    This is indeed a very interresting post, on par with the article on the communist influence on development of acupuncture.

    Using these fantastic pieces of research, it should be possible to assemble a short manifesto of acupuncture myths debunked, complete with references. Worded efficiently and catering to journalists it could be released as a press release for a quick copy/paste story in newspapers and blogs. The angle being: “Ancient Art of Acupuncture: Communist propaganda or spiced up astrology?” This stuff should really be communicated out to the masses.

    I always get all fired up when I’m presented with new ammunition for fighting quacks (and loud acquaintances who claim knowledge of all things true about CAM)

  7. Ben Kavoussi says:

    I thank everyone for all the encouraging and instructive comments. It’s great to communicate with likeminded individuals who share the same concern of seeing voodoo-science become the basis for healthcare policy in many states, mainly due to the legal and legislative initiatives by profit-minded practitioners and their advocates and attorneys–none of which have any backgrounds in biomedical sciences or in primary care. As a result the consumer is always presented with misinformation.

    For instance the CA Dept of Consumers Affairs (DCA) has recently published a Consumer’s Guide to Acupuncture and Asian Medicine which alleges that the NIH “formally endorses” its use for a set of specific conditions, and that there is “clear evidence” that it is effective for some of them. The booklet is available at:

    http://www.acupuncture.ca.gov/pubs_forms/consumer_guide.shtml

    I brought this to the attention of NCCAM and got a candid response stating that “the booklet misstates the purpose of a 1997 consensus panel on acupuncture,” and that as a “Federal research agency, the NIH does not endorse any product, service or treatment, nor are NIH consensus documents statements of policy.”

    When I forwarded their response to the DCA and to its Board of Acupuncture (Board), I got a very interesting response that clearly indicates why acupuncture is “like the zombie that wouldn’t die:”

    “The Board and its legal counsel…concur that the consumer’s guide does not contain erroneous statements on the efficacy of acupuncture. The Board states that the 1997 consensus statement released by the NIH, a part of the U.S. Department of Health and Human Services, clearly states that there is clear evidence that needle acupuncture is efficacious for adult postoperative and chemotherapy nausea and vomiting and probably for the nausea of pregnancy… While the Board acknowledges that the 1997 NIH consensus statement does not specifically state that they formally endorse the use of acupuncture, supporting statements in the report could be defined as an endorsement.”

    In other words, while the NCCAM maintains that the NIH does not endorse any product, service or treatment, and that it is a misstatement to say that the 1997 NIH consensus panel has found “clear evidence” of efficacy for acupuncture, a set of bureaucrats without any of knowledge of scientific medicine and clinical research, and their legal counsel of course, insist that it is otherwise, and therefore an outdated and biased NIH document that is based on pseudo-truth and ill-conducted trials remains the basis for healthcare policy! This is just one example.

    This is why it is indeed imperative, as a commentator has suggested, to assemble a well-referenced position paper on acupuncture and to send it to journalists, the academia, the legislature, or to use it as a press release, a paper perhaps called “Poking the Acupuncture Myth.” Hopefully the zombie dies this time!

  8. Charon says:

    Much more of the Corpus Hermeticum survived than you imply (e.g., http://uwashington.worldcat.org/oclc/24142018&referer=brief_results ). I’m not sure anyone knows how much was lost. As it was rediscovered in Europe during the Renaissance, if the parts discovered fell short of explaining all the mysteries of the Cosmos, then it was assumed much more (the better stuff) remained undiscovered. Which was BS, of course.

  9. TsuDhoNimh says:

    Ben –
    The medical missionaries in China during the 1880-1920 period do report that “needling” was widely practiced.

    Thirty years in Moukden, 1883-1913
    By Dugald Christie (British Doctor)

    The only mode of treatment in vogue which might be called surgical is acupuncture, practised for all kinds of ailments. The needles are of nine forms, and are frequently used red-hot, and occasionally left in the body for days. Having no practical knowledge of anatomy, the practitioners often pass needles into large blood-vessels and important organs, and immediate death has sometimes resulted.

    At least it’s improved a bit.

  10. Geekoid says:

    5200 years old? Something that’s been used that long HAS to work~

  11. mjranum says:

    I’ve always been amazed that practitioners can cite “life energy” in spite of its apparent undetectability. Given that the electromagnetic spectrum is completely understood by physicists, from RF to gamma rays – where IS this “life energy”? We can, and would, detect it if it existed in the real world; i.e.: if it’s not detectable and it’s supposed to be “energy” it’s “not there.”

  12. Ben Kavoussi says:

    The “it must work because it is over 5000 years old” argument is exactly the type of reasoning that must be obliterated from the practice of medicine. Exorcism, sacrifice, magic, necromancy, cleromancy, numerology, geomancy, astrology, fortune telling, palmistry, sorts, talismans, amulets, prayer, offerings and other such nonsense are also over 5000 years old; none of which has ever healed anyone. What amazes me most is the fact that CAM practitioners who reason as such, and sell their useless products and services to desperate patients, never use their 5000-years-old remedies on their loved ones. It is always the “reductionist”and dreadful ER doctor who saves their lives.

    This bogus argument has also served many teaching institutions in the US to prepare “willfully ignorant” voodoo-doctors, while pocketing Title IV financial aid. Their uneducated and unscrupulous graduates in turn take advantage of our excessively liberal laws on the practice of CAM, and provide ailing and desperate people with their 5000-year-old nonsense.

  13. woo-fu says:

    A well-written, well-researched post that I will most certainly share! I especially enjoyed how you traced the global history and evolution of these practices.

    I tried acupuncture myself a few times, after being recommended by a physician to do so. I have fibromyalgia, joint problems, etc. and both my local physiatrist and my neurologist recommended acupuncture. One even had fliers for acupuncture clinics at his check-out window.

    My first acupuncturist was a kind of long-haired doctor feel-good type. It really didn’t hurt, maybe a pinch or two, but I could feel that body rush of endorphins and the sensation of my skin twitching around the needles. I did feel a bit more relaxed upon leaving, but no more so than from a good massage. I didn’t call to schedule a follow-up because I was just too skeptical of the technique.

    I was told by another physician that maybe I was just being too closed-minded. (Gee, I don’t know. To me, if it works, it should work whether or not I believe in the process.) So, I tried one of the most highly recommended acupuncturists in the area. Again, similar feelings of calm, but no lasting effects and this one wanted to see me for at least 10 visits at about $100 per visit, which included chiropractic adjustments, Chinese herbal medicine, homeopathy and raindrop therapy. She claimed she could treat a whole host of disorders. Of course, none of this would be covered by my insurance.

    I only went a couple of times, but once I understood the game plan, I didn’t return. I didn’t buy it. What frustrates me is that I wouldn’t have gone in the first place if it weren’t for the physicians themselves who pointed me in that direction!

  14. Henry says:

    Thank you for the amazing article and I have translated this piece of article on a Chinese anti-TCM site

    http://www.xys.org/xys/ebooks/others/science/dajia10/zhongyi2508.txt

  15. Ben Kavoussi says:

    I am delighted with the great comments you all have posted.

    Concerning TsuDhoNimh’s comments: yes, the Chinese indeed used needles; nonetheless, they were coarse needles, which caused pain and bleeding. Not the painless filiform ones used today.

    Concerning woo-fu’s disappointing experience with an acupuncturist: indeed it is common for many CAM practitioners to push useless products and services. If your physician insists that you must see an acupuncturist, you may want to try to see a physical therapist or a physiatrist that practices “dry needling.” Dry needling is the use of needles for physical or electrical neurostimulation in pain management. It seems to work for certain conditions, such as knee osteoarthritis. It is not based on Chinese nedicine and has nothing to do with the meridians and the metaphysical concepts of yin and yang.

    As for Henry’s translation of the post into Chinese, I am most amazed how fast this was done! Thank you very much. Please do not forget to state that this is an excerpt of an upcoming article in Focus in Alternative and Complementary Therapies (FACT). What is posted here is about 1/3 of the original work. If you are interested in translating the whole article and publish it in a Chinese journal, I can send it to you via email with the explicit authorization form the publisher.

    The two bloodletting images are stored on flickr and you are welcome to use them. Here are the links:

    http://www.flickr.com/photos/27470541@N02/3783370968

    http://www.flickr.com/photos/27470541@N02/3783370924

    Thanks again for all the great comments.

  16. woo-fu says:

    One of the docs who told me to try acupuncture was actually a physiatrist. I thought it was odd that she, as a pain specialist, didn’t recommend other needling techniques like the ones you mentioned since others in her group practiced them. I think she really believes in acupuncture and believed it would help with my constellation of symptoms. The physical therapist I saw wanted me to see a rheumatologist instead, which my doc thought was unnecessary.

    Actually, I should have said “raindrop technique” rather than “raindrop therapy,” but here are a couple of links which may interest readers here:

    http://www.youngliving.us/index.asp
    (technique inventor)

    http://www.naturesgift.com/RDT.htm
    (aromatherapists on dangers of technique)

    I’m sure this would make for a good post all on its own.

    *I tried to submit this comment, but it didn’t show or indicate it needed monitoring. I’m going to try once more. Hopefully, this won’t end up as a repetition.*

  17. Henry says:

    Yes Dr.Kavoussi, eventually I will correct the typos and other errors in translation.

    I would not mind doing the whole article, but it probably would be done in the future. I am not familar with Chinese keyboards and it took me almost 8 hours to translate the article.

  18. As a supporter of acupuncture I suppose my views will be unwelcome here, but I have made a special study of the origins of acupuncture and Chinese medical theory over the last 20 years and have written much on this subject. Mr. Kavoussi’s theories on this topic takes great liberties that are simply not supported by fact. The fact is there is no consensus amongst scholars who study Chinese medicine as to how acupuncture may have begun or even the origins of the point/meridian (jing-luo) system. None exists because there is not enough evidence to support any one theory over any other. It is true that some scholars have postulated that acupuncture may have its origins in lancing practices but these same scholars will also tell you this is just an educated guess and none will stand behind this theory due to a lack of hard evidence. And as for the contention that “Acupuncture is presumed to have its origins in blood ritual, magic tattooing and body piercing associated with Neolithic healing practices” this is even more of a stretch and not at all supported by today’s leading scholars most of whom believe acupuncture likely began during the Han Dynasty perhaps 2,200-2,300 years ago.

    The study of the origins of acupuncture and Chinese medical theory is in a very early stage for such a vast and complex subject with only a small but growing number of scholars taking this subject on in the recent past. It may take another 40-50 years before we can say with much confidence just what lead to the development of acupuncture and its related theories. I have my own theories which support the folk legends that state that acupuncture evolved from early touch therapy but I try to identify these as speculation not fact. It seems Mr. Kavoussi’s primary reason for favoring the theories he does is to discredit the validity of acupuncture as a therapy today. He is of course free to do as he pleases but such blurring of speculation with fact seems out of place in any forum that claims to pride itself on critical thinking and whose readership has relatively little knowledge of such a highly specialized subject.

  19. Ben Kavoussi says:

    Dear Mr. Bauer,

    Thank you for your interesting comments. All views are welcome here, as long as they are based on reliable references, logical reasoning, and an understanding of biomedical sciences and clinical research, things that most US-educated acupuncturists lack. Concerning the origins of acupuncture, I clearly state that it is “plausible” that acupuncture comes from bloodletting. That’s all I have tried to express.

    I had the pleasure of spending a whole week with Dr. Paul Unschuld last fall, when he was lecturing in Northern CA, notably at an event that I hosted in Berkeley. In his lectures, Dr. Unschuld insisted (1) that the interpretation of a natural phenomena is always based on the fundamental assumptions of its time, something Michel Foucault has called an “episteme;” (2) that acupuncture as practiced today in the West has very little to do with the original practice; (3) that there are very few reliable studies in Western languages on the history of acupuncture and Chinese medicine. Please refer to your own interviews with Dr. Unschuld on the last two arguments.

    As for the first argument, it is absurd to believe that acupuncture is the ex-nihilo discovery of one individual, as the prevalent myth wants us to believe. It is also silly to believe that the ancient Chinese had an alternate perception of reality that has allowed them to discover invisible “channels” that no modern technology can visualize. These are New Age fantasies about the Orient that I will further deconstruct in my 2 upcoming posts. The traditional tenets of acupuncture, or anything else of that time, are necessarily based on the episteme of their era of origination: the geocentric universe.

    Indeed, before the Copernican revolution, the whole world, including China, saw the nature according to the principles of the geocentric model. In this worldview, everything “below” was as “above,” meaning according to the configurations of the Heavens. This included health and safety beliefs. Have you ever wondered why there are 361 points if you add all the points on all the so-called “channels?” Let me give you a “plausible” explanation: The length of a “solar” day, meaning the time it takes for the Earth to rotate 360 degrees on its axis, is only 23 hours and 57 minutes. The Sun therefore journeys 361 degrees on the Ecliptic every 24 hours, also called a “sidereal” day, and this observation is reflected on the number of points.

    In sum, there are 361 points (same as the number of degrees in a sidereal day) along 12 meridians (the number of zodiacs), which are named after the hour-angle of the Sun (tai-yang, yang-ming, etc. are terms that describe the hour-angle), in which 5 points are named after the planets (Water, Wood, etc, are the names of the 5 planets). Now, anyone that is not “willfully ignorant,” like most advocates of “traditional” acupuncture in the US, will immediately see that it was modeled after astrology and Sun mythology, and according to an episteme of “as above so below,” just like European bloodletting was. Chinese acupuncture could therefore be accurately described as “astrology with needles.”

    As for “the validity of acupuncture as a therapy today,” I highly recommend that you read Edzard Ernst’s article “The recent history of acupuncture” (Am J Med. 2008 Dec;121(12):1027-8.); and the systematic review of literature by Howard Moffet of Kaiser Permanente Division of Research, which is called “Traditional acupuncture theories yield null outcomes: a systematic review of clinical trials” (J Clin Epidemiol. 2008 Aug;61(8):741-7. Epub 2008 Jun 6). There are also many convincing arguments against the validity of acupuncture on this site. You will see that it does not need the aid of Ben Kavoussi to be discredited!

    My next articles on acupuncture will be posted in a few weeks, I will certainly keep you posted.

    Ben Kavoussi

  20. sstumpf says:

    “As a supporter of acupuncture I suppose my views will be unwelcome here”…Mr. Bauer’s views are welcome however they would be more interesting if he provided references along with his “facts”. Statements such as “there is no consensus amongst scholars who study Chinese medicine as to how acupuncture may have begun or even the origins of the point/meridian (jing-luo) system” would benefit greatly from at least one scholar and a reference to his/her work.

    Bauer has confused consensus with scholarship. Does he oppose intellectual discourse? Ben Kavoussi references two articles in his reply to Bauer so that interested parties can read them and weigh the evidence before drawing a conclusion.

    How about this statement by Bauer: “It is true that some scholars have postulated that acupuncture may have its origins in lancing practices but these same scholars will also tell you this is just an educated guess..” If only the next sentence…any sentence like this…was followed by the words “for example”.

    This is the topper: “The study of the origins of acupuncture and Chinese medical theory is in a very early stage for such a vast and complex subject with only a small but growing number of scholars taking this subject on in the recent past. It may take another 40-50 years before we can say with much confidence just what lead to the development of acupuncture and its related theories”. Am I supposed to take your word on that? Can Bauer at least give a range for how small is small?

    I will offer an author that Bauer and other TCM folks might read: Volker Scheid, Chinese Medicine in Contemporary China: Plurality and Synthesis. Duke University Press, 2002. He is a friend of acupuncture who describes his views on Chinese Medicine including acupuncture which he describes as a folk medicine.

    If my tone is incredulous it is because I once taught research and scholarship to doctorate and master level acupuncture students. As a group, I found acupuncture schools to be unconcerned with this advanced degree academic staple. As a profession I have found a profound anti-intellectual spirit prevails in which references to anything that challenges so-called TCM are anathemic. Bauer’s post is an example.

  21. Ted Priebe says:

    Ben, while I agree with your assessment of the ridiculous education you received from the schools you attended your diatribe about Chinese medical history is disingenuous and misleading as to the facts, as we have discussed on many occasions are mistranslations of the source texts by Europeans. Your legitimate claim and focus should be on why these schools are not compliant with California laws in providing education articulated in Statute which by the way are being addressed by the newly appointed CAB.
    “Needling Therapy” (acupuncture)
    Chinese “needling therapy” zhēn 针 needle zhì 治 to cure, to heal, is and always has been science based.1; 2; 3; 4 “Acupuncture” described by metaphysical terms by the French (French energetics-there is no evidence of meridians or circulating energy; energy is a process –ADP/ATP mitochondria) has been adopted by a large segment of American and European medical doctors and lay acupuncturists as well as sub-standard school programs & certifications.
    The failure of US and European TCM theory, founded on non-scientific notions and metaphysical translations of the Chinese texts, as well as being inconsistent with mainstream medicine, on this we all agree.5; 6 Dismissal of the evidence has contributed to denial of access of needed patient care, in California and the U.S, and disrespect of this great medical modality.
    California B&P Code 4927 (d) defines Needling Therapy (acupuncture) “…to normalize physiological functions, including pain control, for the treatment of certain diseases or dysfunctions…”
    In California we have developed, The Medical Treatment Utilization Schedule (MTUS) California Labor Code Section 9792.24.1—Acupuncture Medical Treatment Guidelines; evidence based in compliance with the DIVISION OF WORKERS’ COMPENSATION QUALIFIED MEDICAL EVALUATOR REGULATIONS LC 3209.3 Licensed Acupuncturists TITLE 8 California B&P Code 9792.21. Medical Treatment Utilization Schedule: Acupuncture (needling therapy) is presumptively correct consistent with the physiological basis of needling therapy and nationally recognized evidence-based treatment guidelines.7
    The Chinese concept of physiological function was understood, highly sophisticated for its time and involved a dynamic view of the function of all body systems. This early documented understanding embraces Cannon’s concept of feedback control of “homeostasis” as well as the unstable feed-forward aspects of hormone mediated vitalities and emotions called “allostatis”. Selection of neurovascular nodes are correctly based on the longitudinal distribution of nerves, blood vessels and arteries, lymphatic and segmental dominance through muscle distributions specific in relation to pathology and injury.1; 6; 7; 8; 9; 10; 11; 12

    Adopting semantics such as dry needling or percutaneous nerve stimulation supposedly rediscovered by Travell & Simmons (actually validating the “trigger point” discoveries of the early Chinese) does not change history or proper application of this modality. All proponent’s claim these theories and applications to be an adaptation of Chinese acupuncture, while proclaiming acupuncture points are derived from vastly different concepts, without qualification of this perceived difference, as we all have the same physiology.13; 14 This has led to inconsistent data in research design; unreliable methodology and underutilization.

    Ted Priebe, OMD
    Doctor of Oriental Medicine
    Lic. No AC-2184
    Appointed Member, Medical Evidence Evaluation Advisory Committee (MEEAC)
    California Department of Workers’ Compensation, Medical Unit
    http://www.tedpriebe.com 310-801-1462
    References:
    1. Kendall DE. Dao of Chinese Medicine: Understanding an Ancient Healing Art. Oxford University Press, London, Hong Kong, New York, 2002.
    2. Kendall DE. Energy-meridian misconception of Chinese medicine. Schweizerische Zeitschrift für Ganzheits Medizin: Swiss Journal of Integrative Medicine, 2008;20(2):112-117.
    3. Ulett GA, Han SP. The Biology of Acupuncture. Warren H. Green, Inc. St. Louis, Missouri, 2002.
    4. Ulett GA, Han JS, Han SP. Traditional and Evidence-Based Acupuncture: History, Mechanisms, and Present Status. Southern Medical Journal Dec 1998:91(12) 1115–20.
    5. Filshie J, White A, Editors. Medical Acupuncture, a Western Scientific Approach. Churchill Livingstone, London, 1998.
    6. Macdonald AJR. Acupuncture’s non-segmental and segmental analgesic effects: the points of meridians. In: Medical Acupuncture, a Western Scientific Approach. Filshie J, White A, editors. Churchill Livingstone, London, 1998.
    7. Council of Acupuncture and Oriental Medicine Associations. Acupuncture and Electroacupuncture Evidence-Based Treatment Guidelines. First Edition, Dec 2004.
    8. National Symposium of Acupuncture, Moxibustion and Acupuncture Anesthesia. Advances in Acupuncture and Acupuncture Anesthesia. Foreign Languages Printing House, Beijing, China, 1979.
    9. Kendall DE, A scientific model for acupuncture: Part I. Am J Acup, 1989a;17(3)251-68.
    10. Kendall DE, A scientific model for acupuncture: Part II. Am J Acup, 1989b;17(4):343-60.
    11. Bowsher D. Mechanisms of Acupuncture. In: Medical Acupuncture, a Western Scientific Approach. Filshie J, White A, editors. Churchill Livingstone, London, 1998.
    12. Han JS. The Neuro-chemical Basis of Pain Control by Acupuncture. Beijing, China: Hu Bei Technical and Science Press, 1998.
    13. Simons DG, Travell JG, Simons LS. Myofascial pain and dysfunction: the trigger point manual. Volume 1. Upper half of body. 2nd ed. Baltimore: Williams & Wilkins, 1999.
    14. White A, Cummings M, Filshie J. An Introduction to Western Medical Acupuncture. Churchill Livingstone Elsevier, London New York, 2008.

  22. Ben – please call me Matthew – I would enjoy a constructive dialog with you regarding both the origins of acupuncture and Chinese medical theory as well as the clinical utility of Chinese medicine practices. I really don’t want to engage in snide criticisms and I apologize for any such tone I took in my first post. I guess when I read you referring to acupuncture as the “zombie that would not die” and encouraging readers to refer patients to P.Ts for dry needle therapy, it got my goat seeing how I so deeply believe in Chinese medicine as a valuable healing tool and something I have worked hard improving my skills in over the last 23 years of private practice.

    You obviously have not read my book in which I lay-out my theories of how it came to be that the jing-lou system had 361 points (or 360 or 365 according to other sources) on 12 main and 2 special qi pathways. I completely agree with you that it was inspired by ancient astronomy (with its related astrological overtones) and that subject is a primary theme of my book. However, based on my years of studying Taoist philosophy including a rich tradition of oral folk history as well as my personal practice both as an acupuncturist and Taoist, I came to a very different conclusion about what the astrological roots of acupuncture suggests about its logic.

    I wrote my book in part in the hope that it would encourage constructive discussion with both academia and the Acupuncture/Oriental Medical (A/OM) community. Like you, I have been discouraged by the lack of interest in this subject and I should not want to make an enemy of one of the only others I have run across with a similar interest.

    I treat 15-20 patients a day in my humble practice so I am limited by the amount of free time I have to go into great detail on forums like this (including not including resources –sorry), but, if not in this forum (although I am game) perhaps you and I could communicate further. I really believe we both might enjoy it.

    My book, “The Healing Power of Acupressure and Acupuncture; A Complete Guide to Timeless Traditions and Modern Practice” is available in some public library systems (I know it is in L.A. anyway) or I would be happy to send you a copy. I have not read everything I would like on this subject (too little time) but I am quite familiar with Unschuld, and to a lesser degree with Scheid, Sivin, Hsu, Harper and some others. I have known Howard Moffett for more than 10 years and Ted Prebie and Deke Kendall for twice that time. In short, unlike many you may have run across, I am at least reasonably familiar with both the historic context described by scholars and current research and yet I came to different conclusions.

    Let me know if you would be interested in mutually respectful dialog. It might prove to be quite constructive.

    Best regards,

    Matthew Bauer
    Acu.guy@gte.net

  23. pmoran says:

    How many angels can dance on the head of a pin?

    I am not even sure why skeptics feel it is useful to explain the origins of acupuncture and its theory.

    The critical thing for science and for the progress of medicine is whether it has unique healing powers and the evidence is now fairly conclusive that it works mainly as placebo, and with the same limitations and range of “effects” as placebo.

    That does not necessarily mean (to me) that acupuncture may not have a minor role within medical systems at this point in medical history, where there are many conditions that lack entirely satisfactory answers and the public has a fundamental right to seek relief such placebo medicines if they wish, especially if at their own explense.

    But acupuncture should no longer be considered a matter of serious scientific inquiry, except possibly in helping to unravel the placebo phenomenon and other non-specific patient responses.

    This systematic review is food for thought –

    Linde K, Allais G, Brinkhaus B, Manheimer E, Vickers A, White AR. Acupuncture for migraine prophylaxis. Cochrane Database of Systematic Reviews 2008, Issue 2.

    Authors’ conclusions
    “In the previous version of this review, evidence in support of acupuncture for migraine prophylaxis was considered promising but insufficient. Now, with 12 additional trials, there is consistent evidence that acupuncture provides additional benefit to treatment of acute migraine attacks only or to routine care. There is no evidence for an effect of ‘true’ acupuncture over sham interventions, though this is difficult to interpret, as exact point location could be of limited importance. Available studies suggest that acupuncture is at least as effective as, or possibly more effective than, prophylactic drug treatment, and has fewer adverse effects. Acupuncture should be considered a treatment option for patients willing to undergo this treatment.”

    It will be difficult for the enthusiast to look at acupuncture this way (as placebo). But then, he probably has to be an enthusiast to get good results.

    .

  24. Ben Kavoussi says:

    Dear Matthew,

    My 2 upcoming posts will hopefully respond to many of the questions you have raised. I learned that they will be online by the end of next week. Please read them and we go from there.

    Thank you,

    Ben Kavoussi

  25. Ben Kavoussi says:

    Dear Dr. Moran,

    Thank you for telling me about this systematic review. Howard Moffet has arrived to very similar conclusions:

    “Clinical trials demonstrate that acupuncture can affect outcomes and is distinguishable from a placebo. However, trials that compare acupuncture exposures often observe no statistically significant differences in outcomes. Traditional acupuncture theories, for selecting points, locating them on the body and choosing appropriate stimulation, appear to be unreliable for creating distinct exposures.”

    There is now a considerable body of evidence that it does not really matter where you put the needles, as long as it is a safe area. Believe it or not, I have heard this from very experienced acupuncturists. And this is what George A. Ulett and Songping Han have been saying for many years, notably in “The Biology of Acupuncture” (Warren H. Green; 2001). They think it is the sympathetic response from the pain and injury that is responsible for the observed results, since the autonomic response can modulate the innate immunity.

    The colleagues just do not want to hear that the so-called Oriental medicine they have learned and practice is just astrology-based verbiage of Bronze-Age China that the Wiccan/New Age/Postmodern crowds now like to hear. Please read the upcoming post on the origins this socio-cultural phenomenon. It is called “Oriental Medicine or Medical Orientalism?”

    Best regards.

  26. LOOK AT THE MOON

    First and foremost, I want to stress why I am so passionate about the subject of the viability of acupuncture and Oriental medicine (A/OM). It is not because I like to engage in intellectual debates for the sake of debating but because I am convinced beyond a shadow of the doubt that A/OM is an extremely valuable healing resource that despite its growing popularity is being tragically underutilized. To my mind this debate is, or at least should be, about helping pain and suffering. Like so many of my colleagues, I have helped thousand of real people with real problems over more than 20 years of clinical practice and would happily relate cases that cannot be explained by the placebo hypothesis so popular with today’s acupuncture skeptics. I have no doubt however, that such individual case histories would be rejected as not proving anything. Instead, I will offer my critique on what I believe to be wrong with the logic of many acupuncture critics.

    There is an old Chinese saying that states when using a finger to point out the beauty of the moon, remember to look at the moon – not the finger. In other words don’t confuse the means with the end. If we agree that the desired end of medical investigations is to understand how to better help reduce pain and suffering, then I would contend that many so called “skeptics” or “critical thinkers” have become more concerned with the means than the end. Why do I believe this? Just look at the responses to recent acupuncture studies.

    One of the most recent and comprehensive studies on acupuncture sometimes referred to as the “Seattle” study .1, showed that acupuncture and a simulated acupuncture procedure (tapping acu-points with tooth picks) was twice as effective as conventional therapy in treating chronic low back pain. This study’s finding were similar to a series of trials conducted in Germany.2 that found acupuncture including so-called sham acupuncture to be over 50% more effective than conventional therapy for chronic low back pain with the author of the German trails concluding:

    “Acupuncture constitutes a strong alternative to multimodal conventional therapy. Acupuncture gives physicians a promising and effective treatment option for chronic low-back pain, with few adverse effects or contraindications.”

    Not only is chronic low back pain one of the most common problems seen clinically, it is also quite difficult to effectively treat and many who suffer this malady rely on medications that have been shown to have dangerous side-effects. The FDA’s own advisory panel recently warned about popular pain medications (used by many chronic low back pain sufferers) i.e., Tylenol (Acetaminophen) and Tylenol containing drugs such as Vicodin, as being the leading cause of liver failure. 3. So not only do these recent trails show how much more effective acupuncture techniques are than conventional therapy for chronic low back pain, acupuncture also has a much better safety record. But what did the science based skeptics take away from these studies that showed an alternative therapy that is one and a half to two times as effective as conventional therapy and much safer? They ignored the good news regarding the “ends” of a better and safer therapy and chose instead to focus on the questions that remain regarding the “means” by which acupuncture techniques work.

    MOVING THE GOALPOSTS

    What is even more frustrating about these recent developments is the evolution of the criticisms of acupuncture. Twenty years ago, acupuncture’s critics actively campaigned to abolish acupuncture licensing charging that acupuncture had never been proven to effectively treat any disease. 4. That is why acupuncturists believed the National Institute of Health’s 1997 Consensus Conference findings to be a milestone for acupuncture in that this independent scientific panel reached the conclusion that in at least two conditions – nausea, and post-operative dental pain – acupuncture had met the burden of scientific proof of effectiveness its critics argued had never been shown. 5. Acupuncture’s critics however, would not accept that their main argument had been proven wrong and blasted this finding as being biased charging the NIH panel as being “engaged in pseudoscientific reasoning.” 6.

    In the following years, studies such as the German trails and the Seattle study have repeatedly shown acupuncture and acupuncture like techniques to be more effective than conventional therapy. But acupuncture critics now seem to have forgotten their original charge that acupuncture has never been shown to be effective for any disease and now charge that these studies prove acupuncture’s “effectiveness” is due to the placebo effect and that traditional acupuncture techniques are no more effective than sham acupuncture. This is an old tactic sometimes called “moving the goalposts.” Level a charge and if this charge is met, level a new charge. I have been watching this tactic be used against acupuncture for 25 years and see this again in some of the post on this site.

    Consider the criticism in a recent posting on this thread by pmoran who offers a quote from a recent Cochran Database study on the effectiveness of acupuncture for migraine headache that concluded:

    “Available studies suggest that acupuncture is at least as effective as, or possibly more effective than, prophylactic drug treatment, and has fewer adverse effects.”

    While this would seem like good new for migraine headache sufferers, Dr. Moran wrote that:

    “The critical thing for science and for the progress of medicine is whether it has unique healing powers and the evidence is now fairly conclusive that it works mainly as placebo, and with the same limitations and range of “effects” as placebo.”

    Dr Moran believes then that the “critical” thing is demonstrating “unique healing powers.” That may be true for those more concerned with the means rather than the end but what is critical to patients is safety, effectives, and cost effectiveness – three heavy burdens that acupuncture has been meeting for more than 2,000 years (that is why the zombie won’t die, Ben).

    Then Ben responded to Dr. Moran’s post by citing a study done by Kaiser’s Howard Moffett that states:

    “Clinical trials demonstrate that acupuncture can affect outcomes and is distinguishable from a placebo. However, trials that compare acupuncture exposures often observe no statistically significant differences in outcomes. Traditional acupuncture theories, for selecting points, locating them on the body and choosing appropriate stimulation, appear to be unreliable for creating distinct exposures.”

    So here, a researcher states that “acupuncture can affect outcomes” (the original goalpost), and “is distinguishable from placebo” (the second goalpost), but that traditional theories of point selection and techniques appear unreliable for “creating distinct exposures” (the new goalpost.)

    IN A NUTSHELL

    Acupuncture techniques have been proven to demonstrate superior safety and effectiveness and this is according to the very studies that are cited by its critics as reasons to suspend further research and any support of acupuncture as a treatment method. Ask yourself what is more important? Some individuals’ interpretation of what constitutes fidelity to the “scientific method” (the means) or therapy even critics acknowledge have been proven safer and more effective than conventional therapy to ease pain and suffering (the ends)?

    As I have followed acupuncture critics’ logic over the years, I believe this is the crucial difference of opinion I and many of my colleagues have with them. I see acupuncture effectively relieving pain and suffering everyday in my practice and in the practices of many others around the world. That takes precedent with me especially considering the high rate of adverse reactions seen in conventional (especially drug) therapy. Many acupuncture critics believe the scientific method takes precedent. To these critics I would ask that they give us more time – now that the goalposts have been repeatedly move back from just showing acupuncture can be effective in treating at least some diseases to proving traditional acupuncture techniques are more effective than sham techniques. I believe this will eventually be shown especially considering that most successful acupuncturists see something more like 75%-85% effectiveness for our chronic low back pain, for example, while the subjects in the recent studies referenced above only showed 45%-60%.

    While those of you that are convinced that acupuncture only works by the placebo effect may not feel right about actively referring patients for acupuncture, I would hope you would at least begrudge that acupuncture has shown itself to be more effective and less risky than conventional therapy in some difficult to treat conditions. I would further hope that you might refrain from campaigning against the use of acupuncture and thus encouraging the public to use more risky and less effective therapies.

    1. Daniel C. Cherkin, PhD; Karen J. Sherman, PhD; Andrew L. Avins, MD, MPH; Janet H. Erro, RN, MN; Laura Ichikawa, MS; William E. Barlow, PhD; Kristin Delaney, MPH; Rene Hawkes, BA; Luisa Hamilton, MD; Alice Pressman, MS; Partap S. Khalsa, DC, PhD; Richard A. Deyo, MD, MPH
    Arch Intern Med. 2009;169(9):858-866. A Randomized Trial Comparing Acupuncture, Simulated Acupuncture, and Usual Care for Chronic Low Back Pain
    2. Michael Haake, PhD, MD; Hans-Helge Müller, PhD; Carmen Schade-Brittinger; Heinz D. Basler, PhD; Helmut Schäfer, PhD; Christoph Maier, PhD, MD; Heinz G. Endres, MD; Hans J. Trampisch, PhD; Albrecht Molsberger, PhD, MD Arch Intern Med. 2007;167(17):1892-1898. German Acupuncture Trials (GERAC) for Chronic Low Back Pain Randomized, Multicenter, Blinded, Parallel-Group Trial With 3 Groups

    3. June 29-30, 2009: Joint Meeting of the Drug Safety and Risk Management Advisory Committee with the Anesthetic and Life Support Drugs Advisory Committee and the Nonprescription Drugs Advisory Committee: Meeting Announcement http://www.fda.gov/AdvisoryCommittees/Calendar/ucm143083.htm

    4. National Council Against Health Fraud “Position Paper on Acupuncture” September 16, 1990 Also note: This position paper was sent to the media and to every state regulatory agency that licensed Acupuncturists.

    5. Acupuncture. NIH Consensus Statement Online 1997 Nov 3-5; month, day]; 15(5):1-34.

  27. Ben Kavoussi says:

    Dear Mathieu,

    Thank you for your elucidating thoughts. Indeed, as you have noticed, this site campaigns against the legislation and use of traditional acupuncture and other unscientific therapies. I strongly invite you to read my upcoming posts: one is on the flurry of interest and research in acupuncture that followed a 1971 anecdotal account of its use in China, and the other on the so-called Oriental medicine that has become popular amongst the New Age crowd. A future post on toxic levels of lead, cadmium and mercury in Chinese herbal remedies will follow. Stay tuned!

  28. Hello Ben,

    I will read and respond. Matthew

  29. woo-fu says:

    Dr. Kavoussi,

    While this post and discussion have been very lively and, I feel, productive, insulting Wiccans, New Agers or any other social group you’ve presumed are anti-science is prejudicial and non-productive. I know several Wiccans who have degrees in science, including PhDs in biology. To assume these individuals blindly accept woo without critical thought is insulting at best.

    To be sure there are plenty of practitioners who are more swayed by myth and emotion, what you might call woo, but the same can be said of practitioners of many other mainstream faiths. On the other hand, in Wicca, as in other faiths, many practitioners are able to utilize storytelling and myth as a construct upon which they develop social rituals and celebrations. For these individuals, allegory is recognized as such and considered a source of inspiration rather than dogma to be taken literally.

    I’ve spent the majority of my years studying science as well as world religions and appreciate the trials and tribulations of their co-evolution. I hope you come to understand that religious practitioners do have the capacity to evolve cognitively without necessarily abandoning the practices that give them joy.

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