ACUPUNCTURE and SHAM are effective

Acupuncture has gained popularity as an adjunct to conventional allopathic medical treatments and is offered even at prestigious academic medical centers.
However, despite numerous studies, the mechanism for how acupuncture might be functional physiologically is yet to be determined.
Hypotheses include that the stimulation influences inflammatory markers induces hormonal changes, or even that the pressure itself manipulates loose connective tissue that causes immunomodulation.
It is theorized that analgesia results as well from the release of natural opioids at both spinal or supraspinal levels. Functional MRI has shown physiologic changes in the central nervous system while undergoing acupuncture.[16][17]

Complementary and alternative medicine modalities are often not candidates for randomized controlled trials, which are the foundation of evidence-based medical practices in the United States.
Acupuncture is no exception.
To perform control acupuncture or “sham” is complicated and mostly relies on non-penetrating needles or the placement of needles at non-acupuncture points.
Another limitation is that acupuncture is an individualized treatment, which makes standardization for a study difficult.
Therefore, acupuncturists often do not feel they can adequately treat patients if they are mandated to perform specific points or techniques for the sake of variable control.
Methods vary as well by school and style, which have variability as to the locations themselves, the manipulation manner, length of treatment, and the desired response from the patient.
Lastly, the theory of health and disease for this modality is not based on Western traditional medical philosophy, which makes the characterization of disease and treatment itself a limiting factor.
All of these dynamics intertwine to make it difficult to prove or disprove the efficacy of acupuncture according to Western evidence-based medicine standards.

It is questionable if acupuncture is clinically superior when compared to sham acupuncture.
However, this does not take into the fact that both acupuncture and sham are effective in the reduction of symptoms and improving the function of patients with back pain, headaches, knee pain, and hot flashes.
Both therapies are superior to no treatment at all [18][19].
SOURCE: https://www.ncbi.nlm.nih.gov/books/NBK532287

Source: Quackwatch.org, "Be Wary of Acupuncture, Qigong, and 'Chinese Medicine'"
by Stephen Barrett, M.D. (December 6, 2022) https://quackwatch.org/related/acu

Main Themes:

Criticism of Traditional Chinese Medicine (TCM): This article presents a highly critical view of Traditional Chinese Medicine (TCM), encompassing acupuncture, Qigong, and herbal remedies, labeling it as "folk medical practices based on mysticism."
Questionable Scientific Basis: The article argues that the theoretical foundation of TCM, particularly the concept of chi and meridians, lacks scientific validation and bears "no relationship to present scientific knowledge".
Dubious Claims of Benefit and Untrustworthy Research: The author contends that claims of acupuncture's effectiveness for various conditions are based on poorly designed studies and practitioners' observations rather than rigorous scientific evidence. Research originating from China is viewed with extreme skepticism due to potential data fabrication.
Risks and Financial Costs: The article highlights potential risks associated with acupuncture, including infections, organ punctures, and misdiagnosis. It also mentions the financial burden associated with TCM treatments and herbal products.
Diagnostic Variability: Studies are cited that show significant disagreement among TCM practitioners when diagnosing the same patient.
Questionable Standards and the NIH Debacle: The article questions the standards and credibility of acupuncture certification and criticizes the 1997 NIH Consensus Conference for being biased towards acupuncture proponents.

Most Important Ideas and Facts:

TCM and Chi: TCM posits that the body's vital energy (chi) flows through channels called meridians. Illness is attributed to imbalances or interruptions in this flow. "Chinese medicine'...encompasses a vast array of folk medical practices based on mysticism. It holds that the body’s vital energy (chi or qi) circulates through channels, called meridians, that have branches connected to bodily organs and functions. Illness is attributed to imbalance or interruption of chi."
Acupuncture Techniques: Acupuncture involves inserting needles into specific "acupuncture points" on the body, often combined with techniques like moxibustion, laserpuncture, and acupressure.
Qigong: Qigong is presented as a practice that aims to influence the flow of vital energy. Internal Qigong involves deep breathing and relaxation, while external Qigong is claimed to cure diseases with energy released from the master's fingertips.
Lack of Scientific Evidence for Efficacy: The article states that studies supporting acupuncture's effectiveness are often poorly designed and that a meta-analysis of acupuncture for chronic pain concluded that its efficacy "remains doubtful." "The conditions claimed to respond to acupuncture include chronic pain...However, the evidence supporting these claims consists mostly of practitioners’ observations and poorly designed studies...The efficacy of acupuncture in the treatment of chronic pain remains doubtful."
Acupuncture Anesthesia Misrepresentation: Acupuncture anesthesia is not used for surgery in the Orient to the extent that its proponents suggest; patients are carefully screened, and local anesthesia or narcotics are often used in conjunction.
Possible Explanations for Perceived Effects: The article suggests that pain relief from acupuncture may be due to placebo effect, external suggestion (hypnosis), cultural conditioning, or intense sensory input rather than any specific mechanism of acupuncture itself. "Other theories suggest that the placebo effect, external suggestion (hypnosis), and cultural conditioning are important factors...acupuncture is not a magical procedure but only one of many ways to produce analgesia [pain relief] by an intense sensory input."
Untrustworthy Research from China: Cites evidence that suggests data fabrication is common in Chinese research papers related to TCM. "The quality of TCM research in China has been extremely poor...publication bias may be common; a funnel plot of the 49 trials of acupuncture in the treatment of stroke confirmed selective publication of positive trials in the area, suggesting that acupuncture may not be more effective than the control treatments."
"Sham Acupuncture": Development of "fake needles" allows for better-designed, controlled studies, and one such study showed no significant difference between acupuncture and sham acupuncture in reducing postoperative nausea and vomiting.
Risks of Acupuncture: Potential adverse effects include fainting, hematoma, punctured lung, infections, and nerve damage. "Improperly performed acupuncture can cause fainting, local hematoma...pneumothorax (punctured lung), convulsions, local infections, hepatitis B (from unsterile needles), bacterial endocarditis, contact dermatitis, and nerve damage." The herbs used are unregulated.
Diagnostic Variability: The studies cited illustrate a lack of consistency in diagnoses among different TCM practitioners examining the same patient. "At least six studies have found that when multiple practitioners see the same patient, their TCM diagnoses vary considerably." One study demonstrated that when seven acupuncturists evaluated the same patient with chronic back pain, there was little agreement on the specific acupuncture points that should be used for treatment.
NCAHF Position: "Acupuncture is an unproven modality of treatment...Its theory and practice are based on primitive and fanciful concepts of health and disease that bear no relationship to present scientific knowledge...Perceived effects of acupuncture are probably due to a combination of expectation, suggestion, counter-irritation, conditioning, and other psychologic mechanisms."
TCM poses a threat to certain animal species: Black bears are hunted nearly to extinction in Asia due to the belief that their gall bladders have medicinal value.

Quotes:

"Chinese medicine,' often called 'Oriental medicine' or 'traditional Chinese medicine (TCM),' encompasses a vast array of folk medical practices based on mysticism."
"The efficacy of acupuncture in the treatment of chronic pain remains doubtful."
"Acupuncture is an unproven modality of treatment. Its theory and practice are based on primitive and fanciful concepts of health and disease that bear no relationship to present scientific knowledge."
"TCM theory and practice are not based upon the body of knowledge related to health, disease, and health care that has been widely accepted by the scientific community."

Overall Assessment:

This article presents a strongly skeptical and critical perspective on TCM, particularly acupuncture and Qigong.
It emphasizes the lack of rigorous scientific evidence supporting its efficacy, highlights potential risks, and questions the diagnostic reliability of TCM practitioners.
The author advocates for caution and suggests that perceived benefits may be attributable to placebo effects or other psychological mechanisms.
The article also expresses concern regarding the threat to certain animal species and highlights the existence of diagnostic variability amongst practitioners.

Quiz (Short Answer)

Answer each question in 2-3 sentences.

According to the article, what is the fundamental principle upon which Traditional Chinese Medicine (TCM) is based?
Describe the difference between internal and external Qigong, as outlined in the article.
What are some of the risks associated with improperly performed acupuncture?
What are some of the methodological flaws that the article identifies in TCM research originating from China?
How does the article explain the potential pain relief experienced during acupuncture treatments?
What is the significance of "fake needles" in acupuncture research, according to the article?
What does the article suggest is a major flaw in going to practitioners who practice traditional Chinese medicine?
What did the author experience when he went to see a TCM practitioner?
According to the article, what are some of the issues related to the safety, potency, or effectiveness of herbs used by acupuncture practitioners?
According to the NIH Consensus statement, what has the WHO listed acupuncture as indicated to treat?

Quiz Answer Key

TCM is based on the belief that the body’s vital energy (chi or qi) circulates through channels called meridians, and illness is attributed to imbalance or interruption of this energy. Ancient practices like acupuncture and herbal remedies are claimed to restore this balance, but the article suggests there is good reason to be skeptical.
Internal Qigong involves deep breathing, concentration, and relaxation techniques used by individuals for themselves, while external Qigong is performed by "Qigong masters" who claim to cure diseases with energy released from their fingertips. However, the article cites evidence that suggests these masters do not have paranormal powers.
Risks of acupuncture include fainting, hematoma, pneumothorax (punctured lung), infections (including hepatitis B from unsterile needles), and nerve damage, highlighting the importance of properly trained practitioners. Additionally, there is a risk of a practitioner whose approach to diagnosis is not based on scientific concepts will fail to diagnose a dangerous condition.
The article identifies several flaws, including inappropriate randomization methods, infrequent use of blinding, small sample sizes, the use of ineffective control treatments, and publication bias, leading to unreliable research outcomes.
The article suggests that the perceived pain relief from acupuncture may be due to the placebo effect, external suggestion (hypnosis), cultural conditioning, or intense sensory input rather than a direct physiological effect of acupuncture itself.
"Fake needles" enable researchers to conduct better-designed, controlled studies by creating a placebo effect that mimics the sensation of acupuncture without actually penetrating the skin, thus helping to isolate the true effects of acupuncture.
The article suggests that a major flaw in going to practitioners who practice traditional Chinese medicine is that you are unlikely to be properly diagnosed.
The author was diagnosed by an experienced TCM practitioner via pulse and tongue examination, as having "stress" and "congestion of the blood." The author took another woman's pulse, who was diagnosed with a heart issue, and found that it was completely normal, suggesting improper diagnostic procedures.
Herbs used by acupuncture practitioners are not regulated for safety, potency, or effectiveness.
WHO has listed that acupuncture may be indicated to treat more than 40 conditions. The author believes this list was not valid.

Glossary of Key Terms

Chi (Qi): In TCM, the vital energy that circulates through the body and is believed to be essential for health.
Meridians: Channels through which chi is believed to flow in TCM, connecting to bodily organs and functions.
Acupuncture: A TCM practice involving the insertion of needles into specific points on the body to stimulate chi flow.
Qigong: A TCM practice involving coordinated body-posture and movement, breathing, and meditation.
Moxibustion: Burning of floss or herbs applied to the skin in TCM.
Auriculotherapy: Placement of needles in the external ear.
Acupressure: Use of manual pressure on acupuncture points.
TCM (Traditional Chinese Medicine): A range of folk medical practices based on the belief that the body's vital energy (chi or qi) circulates through channels, called meridians, that have branches connected to bodily organs and functions.
Placebo Effect: A beneficial effect produced by a treatment that cannot be attributed to the treatment itself, and therefore must be due to psychological factors.
NCCAOM (National Certification Commission for Acupuncture and Oriental Medicine): An organization that sets voluntary certification standards for acupuncturists and practitioners of Oriental medicine in the United States.
ACAOM (Accreditation Commission for Acupuncture and Oriental Medicine): An accrediting agency recognized by the U.S. Secretary of Education for acupuncture and Oriental medicine programs.
Pneumothorax: Punctured lung, a potential risk of acupuncture.
Endorphins: Narcotic-like substances produced by the body, theorized to be stimulated by acupuncture.
Publication Bias: The tendency for research findings to be published based on their nature and direction of their results.
Meta-analysis: A statistical procedure for combining data from multiple studies.
Randomization: A method based on chance alone by which study participants are assigned to a treatment group.
Blinding: A study technique in which the study participants do not know which treatment they are receiving.

Frequently Asked Questions about Acupuncture, Qigong, and Traditional Chinese Medicine (TCM)

1. What is Traditional Chinese Medicine (TCM) and what are some of its core beliefs?

TCM encompasses a wide range of folk medical practices rooted in mysticism. It posits that the body's vital energy (chi or qi) flows through channels called meridians, connected to organs and functions. Illness is attributed to imbalances or interruptions in this energy flow, which practices like acupuncture and Qigong aim to restore. TCM diagnostic processes include assessing medical history and lifestyle, observing physical characteristics (skin, tongue, color), listening to breathing sounds, and pulse-taking (checking six pulse aspects on each wrist).

2. What is acupuncture and how is it performed?

Acupuncture involves inserting stainless steel needles into specific points on the body called "acupuncture points," which proponents claim number around 2,000. Practitioners may use a low-frequency current to stimulate the needles. Other procedures sometimes used in conjunction with acupuncture include moxibustion (burning herbs near the skin), injecting sterile solutions through the needles, laserpuncture, auriculotherapy (ear acupuncture), and acupressure.

3. What is Qigong, and how is it supposed to work?

Qigong is another practice claimed to influence the flow of chi. Internal Qigong involves deep breathing, concentration, and relaxation performed by individuals. External Qigong, practiced by "Qigong masters," claims to cure diseases by releasing energy from their fingertips. However, studies have found no evidence of paranormal powers in Qigong masters and some evidence of deception. A variant of Qigong, Falun Gong, is banned in China.

4. What conditions are claimed to be treated by acupuncture, and what does the research say about its effectiveness?

Acupuncture proponents claim it can treat a wide range of conditions, including chronic pain, acute injury-related pain, gastrointestinal problems, cardiovascular issues, genitourinary problems, muscle and nerve conditions, and behavioral problems. However, the evidence is generally weak. Many studies are poorly designed, and some suggest that acupuncture is no more effective than a placebo. A meta-analysis of studies on acupuncture for chronic pain concluded that its efficacy remains doubtful, and another found no support for claims that it effectively treats addiction.

5. How might acupuncture potentially relieve pain, according to various theories?

Several theories attempt to explain how acupuncture might relieve pain. One theory suggests it blocks pain impulses from reaching the spinal cord or brain. Another proposes that it stimulates the body to produce endorphins, which reduce pain. Other explanations include the placebo effect, hypnosis, and cultural conditioning. Some suggest that any form of intense sensory stimulation at acupuncture points can produce analgesia (pain relief).

6. What are the risks and potential adverse effects associated with acupuncture?

Improperly performed acupuncture can cause fainting, hematoma, pneumothorax (punctured lung), convulsions, infections, hepatitis B (from unsterile needles), bacterial endocarditis, contact dermatitis, and nerve damage. The herbs used by TCM practitioners are unregulated, posing further risk. There's also a risk of misdiagnosis by practitioners not using science-based diagnostic methods, potentially delaying appropriate medical care.

7. Are there issues with the quality and reliability of research on acupuncture and TCM?

Yes. Research from China has been found to be unreliable and even faked. There have been issues noted with research methodology. Some studies have been designed so poorly that no conclusions can be drawn. Researchers have developed "fake needles" to help better control for placebo effects when studying acupuncture.

8. What are the concerns about the diagnostic process used by TCM practitioners?

A major concern is that TCM diagnoses are highly variable and lack consistency. Studies have shown that when multiple TCM practitioners examine the same patient, they often arrive at different diagnoses and recommend different treatments. This suggests that TCM diagnoses are not consistently related to the patient's actual health problems, raising concerns about the reliability and validity of the diagnostic process and calling into question the usefulness of consulting a TCM practitioner for health issues.

ACUPUNCTURE

Clinical Significance

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