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The journal's mission is to use science to re-evaluate tradition in understanding acupuncture. But it is sometimes difficult to free oneself from the concepts of traditional Chinese acupuncture. It is a bit like traditional sticky toffee, stuck between the teeth. There are five pieces of sticky toffee in this issue, and varying degrees of success at dealing with them.
The most obvious, and persistent, tradition of acupuncture is the idea of ‘correct’ acupuncture points for a particular condition. In a nicely performed RCT, Kim and colleagues used a consensus of ‘correct’ points for treating hot flushes and compared them with what they assumed were ‘incorrect’ points. In line with much of the evidence from other trials, they found no difference: hot flushes declined in both groups. Acupuncture's effect in this condition is a general effect on central nervous system mechanisms – by some (still unknown) combination of sensory nerve stimulation and expectation.
Still on the traditional use of points, in our education section Cheng compares traditional indications for individual points, as published in classical texts, with their segmental level of innervation. For points on the trunk, there is a good match. But traditional indications for points on the limbs do not correlate with their innervation. The particular piece of sticky toffee here is the idea that ST36 is linked with the gastrointestinal tract, for example. The effect of acupuncture at limb points on central nervous system is general not point specific–exactly what Kim and colleagues just showed.
The third piece of toffee, about needle sensation, seems really stuck hard: needles are best inserted deeply if you want to generate needle sensation; and rotating the needle increases the sensation. Park and colleagues confirmed these ideas by introducing ultrasound control of needle depth. So clear are the relationships between depth, rotation and needle sensation that they showed up in this tiny study with only five participants.
Turning to traditional diagnosis, we find another piece of toffee that we can live with: Mist and colleagues showed that traditional diagnosis is reliable, which is not surprising since it essentially consists of placing reliable information in categories. Earlier studies have been less convincing, but probably had methodological problems. These authors identified three categories in a population of patients with fibromyalgia. Our commentary aligns these categories with fibromyalgia subtypes recognised in Western medicine, which interestingly have implications for treatment.
The fifth paper on our sticky toffee theme is about the enduring notion that ‘points’ show electrical characteristics which are different from those of ‘non-points’, and which reflect sickness and particularly allergy. Colbert and colleagues reviewed the most reliable studies and find a little evidence to support the idea that points are specific and relate to disease, though not to allergy. This particular piece of toffee needs more chewing over.
Turning now to straight scientific tests of the effects and mechanisms of acupuncture, we include two laboratory-based RCTs investigating electroacupuncture effect on insulin resistance and on liver dysfunction caused by endotoxins.
In a speculative piece, Cakmac uses his knowledge of the mechanisms of breast feeding as currently understood to theorise on the mother's role in her infant's colic. Lundeberg comments that the idea is interesting, and adds that there are reasonably well understood mechanisms for acupuncture of the infant to be effective, anyway.
The case histories are worthy of attention: acupuncture for a clarinettist (figure 1), electroacupuncture used for a patient with a totally artificial heart; acupuncture and amenorrhoea of exercise; and an unusual complication of ‘acupuncture’. Our letters are also particularly worthy of attention: a survey of acupuncture in primary care; an RCT showing that acupuncture is worth using only when there are effects to be had (!), and effects of acupuncture in chronic pelvic pain.
The BMAS (British Medical Acupuncture Society) marks with sadness the loss of a very distinguished Honorary member, David Bowsher, honoured here in an obituary by John Thompson.
Finally, we welcome Shaz Burton to the role of Media Reviews Editor with her first review on an important new book from Germany; and at the same time I want to thank Colin Lewis who has been Media Reviews Editor as long as I can remember.
Competing interests None
Provenance and peer review Commissioned, internally peer reviewed.
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