“The imperilled acupuncture skeptic”

[Blue Wode]

Good to see skeptics taking a stance in China:
http://www.theglobeandmail.com/serv...dicine11/BNStory/specialScienceandHealth/home

BEIJING — In the space of a few weeks, Zhang Gongyao has gone from little-known scholar of medical history to one of China's most notorious intellectuals.

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It's all because he dared to question one of his country's most cherished beliefs: Chinese traditional medicine.

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…despite all the forces against him, Mr. Zhang has dared to challenge the establishment. He has warned that traditional medicine is often unscientific, unreliable, dangerous, a threat to endangered species and even fatal to humans in some cases.

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“From the viewpoint of science, Chinese traditional medicine has neither an empirical nor a rational foundation,” he wrote in an article that ignited a furor when it found its way onto China's Internet. “It is a threat to biodiversity. And it often uses poisons and waste as remedies. So we have enough reasons to bid farewell to it.”

In fact, there is strong evidence to support his concerns. British health officials recently warned that Chinese herbal remedies can contain poisonous plant extracts and toxic ingredients such as arsenic, mercury and asbestos. One herbal remedy has an ingredient that is reportedly linked to bladder cancer and kidney damage. And another Chinese herb, ephedra, was banned by Health Canada after it was suspected of links to heart attacks and strokes.

-snip-

The professor won a surprising amount of support on some Chinese websites. One person commented that traditional medicine needs to prove itself scientifically, or else it should be dismissed as witchcraft. Another person, a medical student, said she wished her university would stop teaching traditional medicine, which she regarded as mythology.

Chinese newspapers pointed out that China has about 270,000 traditional-medicine practitioners today, far fewer than 800,000 in the early 20th century. Meanwhile, the number of physicians trained in Western medicine has soared from 87,000 in the early 20th century to about 1.75 million today.

“If the government wants people to trust traditional medicine, it must make a greater effort to prove the reliability and scientific basis of traditional medicine,” the respected newspaper Southern Daily commented. “Otherwise, traditional medicine will keep declining every day.”

...and the market focus will increasingly be shifted to the West where unregulated Traditional Chinese Medicine outlets are already becoming commonplace in shopping malls and high streets.

 

[Blue Wode]

Looks like the news is spreading. From today’s Independent:

In the West, traditional Chinese medicine just goes on growing. Huge numbers swear by it, and it is endorsed by celebrities from Prince Charles to Cherie Blair. Who, then, should be taking a great big acupuncture needle and trying to puncture this bubble but ... the Chinese?

More and more of them are rejecting their ancient remedies in favour of Western medicine. A proposal to remove from the Chinese health care system traditional Chinese medicine (TCM), which includes such treatments as herbal remedies, acupuncture and massage, has divided public opinion and outraged the government.

More…
http://news.independent.co.uk/world/asia/article1963465.ece

 

[Soapy Sam]

One feature of the use / misuse /abuse of the word "accupuncture" in the west is that any "therapy" except injections which involves either needles, pressure or electromagnetic induction, is described as "accupuncture" .

A physiotherapist using an accupuncture needle to trigger the release of a spasmed muscle , is NOT practising accupuncture- but he probably thinks he is - and so does the patient.

 

[Blue Wode]

A physiotherapist using an accupuncture needle to trigger the release of a spasmed muscle , is NOT practising accupuncture- but he probably thinks he is - and so does the patient.

Interesting.

Would that be the same as ‘dry needling’ or ‘Western acupuncture’?
http://www.hadleywoodhealthcare.co.uk/needling.asp

If so, do you know if there’s any good evidence for it?

 

[Amapola]

Blue Wode, THANKS for the link. I have just sent it to a friend who will believe just about anything, so long as it is goofy ideas about health. I have been striving for years to get her to think a little more rationally. She is constantly sending ME articles spouting errant nonsense about acupuncture etc. so it is a great relief to be able to send HER some evidence that just because something is really old and has been done for a long time, it does not mean it is the right thing to do.

 

[Soapy Sam]

Interesting.

Would that be the same as ‘dry needling’ or ‘Western acupuncture’?
http://www.hadleywoodhealthcare.co.uk/needling.asp

If so, do you know if there’s any good evidence for it?

I know a lot of physiotherapists use it.(Which is not an answer to your question)

For some reason, I cannot open the link. (I'm sure the problem is at my end). I'll just tell you what I have been told.
This is way out of my line, you appreciate. I'm relying on what I'm told by several friends who are physios, including a college lecturer and a hospital rehab department manager.
It seems there is a theory (which may have tons of supporting evidence, or none, I do not know), that muscle can go into spasm to protect itself and it's supportive framework when overstressed. This spasm can be released by applying mechanical pressure to trigger points, which (I assume) are specific enervated locii in each muscle. The release is mechanical / physical- we're not talking about "freeing negative chi" here, but about making bundles of muscle fibres relax and extend (or in some cases, contract), past each other, so the muscle takes up a correct geometry.
The release can be triggered by specific pressure, by nerve induction, mild electroshock or- in some cases- by inserting a needle. I get the feeling almost any specifically targeted physical force could do. Massage, I assume has the same effect. The trick is to target the trigger points without further trauma to areas around them- and probably to position the affected muscle and any paired complementary muscle in such a way as to let it relax.

I repeat- I do not know if this model is backed by research or not, but I do know it seems commonly believed among physios who do not know each other, so I presume it's in their professional literature. I find it a bit vague, but I'm in no position to debate it.

What had surprised me is how readily physios seemed to accept accupuncture as an effective modality of treatment - but it's clear that if they mean using needles in this way, they are not using accupuncture per se, any more than I would be practising Feng Shui if I moved my chair because I found it more comfortable near the fire.

Perhaps the poster named Physiotherapist can supply more info. I will PM.

 

[Physiotherapist]

A lot of my colleagues do use dry needling as another way of treating trigger points. I believe that there is some evidence, but I would have to look up a few articles.

I don't and never have used this technique for treating TrP's.

Basically, trigger points are normally found in the belly of a muscle and are areas of increased sympathetic fascilitation. They are linked to chronic pain and when pressed will cause pain that refers to another area of the body. e.g. a TrP in Upper trapezius might well refer up into the neck. The way that I treat is when I find a trigger point when I am working, I will press on it and keep doing this until the nature of the pain changes. When this changes, I will then find a position of ease for the patient, and wait for a release where the pain is significantly reduced or totally gone. I then apply a local stretch to the tissue where the TrP in housed and then I do a global stretch, so that I am stretching the whole muscle that contained the Trp.

A lot of the time this seems to work and if the TrP returns, it is normally not as severe as before. By stretching the muscle you are also have an effect on the nervous system and this is also what dry needling is doing too.

A lot of the time, I find that when TrP's do not release successfully, more massage/bodywork is needed to release more general tension in the tissue. To do this, I use a lot of myofasical release and soft tissue release. This ususally releases the tisue sufficiently so that I can then treat the TrP successfully.

I hope this answer provides what you are looking for? Trp's can be treated with bodywork techniques or dry needling.

I will try and look up some articles on dry needling. As I say, I have never used this, as I enjoy the bodywork side of things more and find that I can get really creative doing this kind of work. During my time in Physical therapy, I have branched out into sports massage and deep tissue massage work which I really enjoy. It is also good to work with some super fit athletes for a change!!

 

[Blue Wode]

Thank you Soapy Sam and Physiotherapist for such full replies.

Upon investigating dry needling a little further, it does indeed seem to have some value:

Dry-needling appears to be a useful adjunct to other therapies for chronic low-back pain.

Acupuncture and dry-needling for low back pain (Cochrane Review)
http://www.update-software.com/Abstracts/ab001351.htm

So perhaps at the end of the day dry needling for musculoskeletal disorders/mild pain relief is all that acupuncture (of any variety) will be shown to be useful for. What’s more, if fully qualified manual therapists are already using it, it could well see the eventual demise of traditionally trained acupuncturists.

Amapola, I share your sentiments. Regards the link, the full text of articles published in the Independent are often only available for a few days, so you might like to copy it before it disappears. Fortunately, if you do a search for “Zhang Gongyao acupuncture” you’ll find quite a lot of other links that look at the issue.

 

[Amapola]

Thanks for the heads up, Blue Wode. I have now copied the article for future reference.

BTW, I am a "wode warrior" having dyed with the yellow wode that grows all over here in the US. Apparently the European settlers brought wode with them as a useful plant and it is now considered a noxious weed. To my knowledge we do not have blue wode here. More's the pity.

 

[Soapy Sam]

PT- Thanks for that. I wasn't too far off, except I thought TrP s were fixed points in each muscle, whereas you make it clear the TrP is related to the locus of the problem.

As you are in the USA and the PTs I know are British, we are clearly talking about a widely accepted model.

Nothing there about chi or meridians, I notice.

 

[Physiotherapist]

Yes, I think TrP's are accepted now as being a part of chronic pain that refer to other areas of the body. They can be felt as taught bands within the muscle when performing massage or myofascial techniques. They can also be noted as areas where the skin texture generally might change, becoming slightly sweatier and with increased heat - this is a sign of increased sympathetic activity.

As I mentioned previously, the treatment is all about trying to de-activate the TrP, by flushing it and then taking the body part to a position of ease and then stretching out the tissue that housed the TrP.

TrP's don't have anything to do with Qi or Meridians, although I am sure some acupuncturists might work in this way. They will normally be found in the belly of a muscle itself and refer to other areas.

Travell and Simmons have published at length on TrP's. The seminal work I suspect.

 

[Deetee]

Good to see skeptics taking a stance in China:
http://www.theglobeandmail.com/serv...dicine11/BNStory/specialScienceandHealth/home

Interesting.

The State Administration of Traditional Chinese Medicine, was equally fierce in its attacks on Mr. Zhang. “The farce of going against our ancestors should stop,” the agency said. “The online petition, due to its anti-historical and anti-scientific nature, has caused outrage from people involved in the traditional Chinese medicine sector".

Anti-scientific?

The Chinese news media recently reported that a man in Jilin province has been astonishing his neighbours by walking like a bear in a park every morning for the past several years because a traditional medicine doctor had advised him that a bear-like gait would cure him of heart disease and hypertension.

That's more like it - Science in action.
To argue against such remedies is clearly anti-scientific.