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We feature two major controversies in acupuncture: whether some acupuncture points should be ‘forbidden’ in pregnancy, and whether special precautions are needed in using electroacupuncture (EA).
The pregnancy debate is contentious, and attracts three articles, nicely illustrating a common dilemma of the modern acupuncturist. There is no shortage of traditions handed down from the ancient physicians, as discussed by Betts and Budd; some of these should be respected because they are based on close clinical observation – but which ones? We are revisionists, reinterpreting the mechanisms of acupuncture from our knowledge of human physiology, but Da Silva and colleagues have been vilified for doing this publicly: they argue that the concept of Yin/Yang expresses the principle that acupuncture ‘normalises’ the body's physiology and patients should not be denied useful therapy. The third approach is to appraise the evidence, which Cummings does: acupuncture might have some influence on uterine activity but there is no evidence that this is harmful. The sensible practitioner will discuss with the patient the benefits and risks of acupuncture compared with those of drugs, and make an individual judgement.
Our feature on EA started with the report of Inoue and colleagues, who used direct current through acupuncture needles with the aim of restoring function of peripheral nerves, with some success. Sometimes this caused pigmentation of the skin. A similar thing is reported by Miao, and Cummings also describes blackening of a needle caused by an EA machine with an unbalanced output. Another potential problem with EA is that it can interfere with electrical devices: Vasilakos and Fyntanidou gained the cooperation of the cardiology department in supervising EA treatment of a patient with a pacemaker, when no other treatment gave her any pain relief. In his commentary, Cummings has provided a valuable summary of safety considerations of EA. And he provided our Image of Acupuncture to complete the theme.
Turning to our trials section, Scandinavian authors have been productive in this issue: Enblom and colleagues describe a novel methodological approach, which stimulated me to look and comment on what aspects of single subject design could be useful for acupuncture. Skeier and colleagues report their pilot study here on the use of ST36 for infantile colic, as seen in figure 1. Other researchers previously published in this journal used LI4; if the effect is not point specific, then infants should be treated at whichever is less traumatic. Norrbrink and Lundeberg report the use of acupuncture as a potentially valuable therapy for pain from spinal cord injury.
Mori and colleagues take a traditional practice – stimulating points three times with moxa cones – and test it. The rise in skin temperature does not accumulate. Asher and colleagues use the data from a recent systematic review of auriculotherapy to investigate whether publication of the STRICTA criteria led to improved quality of reporting: small improvements can be shown, at last.
Our Education and Practice section pushes the boundaries for readers in two different directions. On acupuncture mechanisms, Hesselink and Kopsky discuss the roles of opioids and the increasingly recognised place of cannabinoids, then postulate that low doses of naltrexone – though normally regarded as an antagonist to the opioids – could actually enhance the analgesic effects of acupuncture. This could be the basis of an important rational integration of acupuncture with pharmaceuticals.
Taking a different line towards more rational treatment, Macdonald has long been promoting the importance of examining patients for areas of tenderness. To make that examination more reliable and objective, he has invented a device to find the boundaries of tender areas. Masters students should note that it comes with some proposals for research projects.
Competing interests None.
Provenance and peer review Commissioned; internally peer reviewed.
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