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In this issue
  1. Adrian White, Editor

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The de qi debate rumbles on, and the questions are many: what is it? who needs it when? how is it different from needle pain? and so on. Western medical acupuncturists feel comfortable inducing a sensation for their sensory stimulation but at the same time slightly anxious that the word ‘qi’ stands at the very heart of the historical, metaphysical understanding of acupuncture. This issue of the journal contributes to the debate: Yu and colleagues observed an association between sympathetic response and de qi; Park's team scrutinised the de qi literature and found some evidence for it; Lundeberg provides us with yet another up-to-the minute summary of its neurophysiology; and, in our Research update section, the RCT by Xu and colleagues shows an effect of de qi on recovery from Bell's palsy. Now we need that information for other conditions.

The Research update, bringing together global research on acupuncture, also describes a rare study design that compares different doses of acupuncture versus acupuncture – on purpose, not the accidental type when using sham needles. While the results are positive, they are not thoroughly convincing. The same section reports a trial of self-acupuncture, of increasing interest. This study found no effect over 4 weeks, which might be not enough time to show up.

The debate also rumbles on about acupuncture's place in in vitro fertilisation (IVF). At what point in the sequence of procedures should acupuncture be given—ovum induction, collection, implantation, or all of them? Isomaya and colleagues found an effect of a ‘blunderbuss’ of four sessions of manual acupuncture with moxibustion in women with previously failed embryo implantation.  But Rashidi's team found only an effect on ovum quality, despite giving acupuncture at each of five critical steps in the IVF process to women with polycystic ovarian syndrome (PCOS). Talking of moxibustion, Lin and colleagues find the safe distance to be 3 cm, shown in figure 1.

Figure 1

Infrared image of moxibustion at SP6.

The effect of acupuncture is enhanced by the relationship with the practitioner. In many trials, practitioners have been constrained from developing therapeutic relationships, usually to prevent any communication that might unblind the participant. The systematic review by Prady and colleagues found this made little influence on the outcome.

Now a plea to laboratory researchers to always consider a third arm in their electroacupuncture (EA) studies: we need to know whether an effect depends on needles delivering what we know clinically as EA, or simply depends on an electrical current.  Lu and colleagues describe an intriguing study where EA, strong enough to cause muscle contraction, appears to alter the distribution of a herbal product Schizandra in different tissues. This finding seems to point to a true synergistic effect, but are the needles necessary?

Do you remember the recent paper on skin conductivity at acupuncture points, describing reduced skin impedance at PC4 compared with surrounding tissue? Wong's letter suggests a non-acupuncture rationale: the conductance of the median vein, inflated by a sphygmomanometer cuff. This possible explanation was missed by the editor and reviewers.

This journal, in its mission to provide evidence on acupuncture's place in medicine, is always willing to publish negative effects of acupuncture, including adverse events—as long as they are reported with due balance. No effective treatment can expect to be free of adverse effects. Practitioners should be aware of all possible events in order to look out for them and deal with them. This issue contains two adverse events, one regrettably due to practitioner error, but the other an unavoidable injury to the inferior epigastric artery. The trauma was closed during catheterisation as described by Kim and Moon.

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Footnotes

  • Competing interests None.

  • Provenance and peer review Commissioned; internally peer reviewed.

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