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A Critical Evaluation of Acupuncture Research

Physiologization of Chinese Medicine in Germany

  • Published:
East Asian Science, Technology and Society: an International Journal

Abstract

As Chinese medicine is going global, it is simultaneously adapting swiftly to local patterns of perception and interpretation, thereby being shaped into hitherto unknown forms. The globalization of Chinese medicine produces multiple localized visions of a healing system whose trademark is an “innate heterodoxy”. Barnes described the “psychologizing” of Chinese medicine in the USA (Barnes Cult Med Psychiatry 22(4):413–443, 1998). In Germany, however, biomedical instead of “holistic” patterns of perception and interpretation and a tendency to “physiologize” prevail among patients and Chinese Medical therapists. Here the recent German Acupuncture trials, and Acupuncture Randomized Trials (ART) and Cochrane data base metaanalysis (Linde et al., 2009a) shall serve as a prominent example of how German research centers around physiological phenomena and how these studies have triggered an international debate concerning the point-specific nature of acupuncture interventions. In order to evaluate the specific effect of acupuncture in randomized controlled trials, verum acupuncture, defined as acupuncture at “classical” acupuncture points, and sham acupuncture, defined as acupuncture at “non-acupuncture points”, are frequently compared. The anatomically exact location and specificity of acupuncture points are basic assumptions underlying this concept. But how clearly divisible are verum and sham acupuncture points if acupuncture physiology itself is a historical construct? To more adequately evaluate acupuncture’s effectiveness future clinical studies will have to tailor their methodology to the reality of the acupuncture encounter.

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Notes

  1. Since the mid-1950s, we can observe a process of standardization of Chinese medicine in the People’s Republic of China that is still ongoing. It is politically, socially, and economically motivated and among other aspects systematically discards psychological and religious elements of Chinese medicine in favor of biomedical interpretations. See Taylor (2005).

  2. Ironically, while Chinese medicine is steadily gaining popularity in Germany, a very recent 2006 online survey by China Youth Daily and Tencent.com revealed opposite tendencies in China itself where TCM is losing out to western medicine in the popularity stakes: “Only 28 percent of the 14,677 respondents surveyed said they would turn to TCM first even though 87 percent said they still had faith in the centuries-old practice. Half of the respondents who voiced their support for TCM believe it is an effective cure for many diseases but 27 percent only trust it because it is “the quintessence of China”. As for the future of TCM, more than 60 percent said they were not optimistic” (China Youth Daily 2006).

  3. “Although we are the first generation ever to have the means of protecting itself from the most deadly and common infectious diseases... underuse and misuse of recent health breakthroughs has been catastrophic for people living and working in developing countries. Two out of every three deaths among young people in the poorest countries of Africa and Asia continue to result from just a handful of illnesses...” (WHO 2000).

  4. See, for instance: http://www.who.int/chp/media/Video_gallery/en/index.html.

  5. For a detailed discussion of the term “TCM” and the transmission of standardized medical knowledge in China see Hsu (1999: 128–224). The Chinese medical community has, according to Taylor, “contributed to the Western illusion of a static, unchanging medical system, by repeated advertising of the long and rich history of their medicine, and by the use of the translation “Traditional Chinese Medicine (TCM)”” (Taylor 2004: 93). In China, Chinese medicine is simply termed zhongyi and never referred to as chuantong zhongguo yixue which would be the correct translation of TCM.

  6. Lehrstuhl für Naturheilkunde der Alfried Krupp von Bohlen und Halbach-Stiftung an der Universität Duisburg-Essen.

  7. http://www.uni-essen.de/naturheilkunde/en/index.php.

  8. Such centers have opened all over the country and offer treatment in Chinese healing methods at quite varying degrees of quality. Because of growing quality concerns, the German government funded this particular study to ensure the quality of services in Chinese medicine.

  9. While it is true that a number of universities in the USA (Harvard, Stanford, University of California, Los Angeles, University of California, San Francisco, etc.) have also established centers of Integrative Medicine, the German department is the only one that enjoys equal status with other medical departments. While lectures on naturopathy and/or integrative medicine are elective courses at these US universities, they are required courses for medical students at the University of Duisburg-Essen.

  10. “The idea of randomization as a method of control was introduced by the English statistician and geneticist Ronald Aylmer Fisher (1890–1962) in an article in the Journal of the Ministry of Agriculture in 1926, and the first randomized controlled trial was designed by the English medical statistician Sir Austin Bradford Hill (1897–1991) and carried out in 1948 by the Medical Research Council of the UK to study the therapeutic efficacy of the antibiotic drug streptomycin” (Oxford Dictionary of Psychology 2003: 614).

  11. See Committee for Evaluating Medical Technologies in Clinical Use (1985: 5).

  12. See http://en.wikipedia.org/wiki/Randomized_controlled_trial.

  13. Starting with early acupuncture studies such as Gaw et al. (1975) and Godfrey and Morgan (1978), to the very recent German GERAC and ART studies that will be discussed in detail below.

  14. See the study cited in Tao (2007)—Gaw AC et al.—and Melzack (1977), or Richardson and Vincent (1986).

  15. The literal translation of mai is vessel and that of shuxue transport loci. In the modern reception, mai has become meridian and shuxue acupuncture point.

  16. See Melchart et al. (2003), Melchart et al. (2005), Linde et al. (2005), and Witt et al. (2005).

  17. Beta-type errors occur if the sample size does not produce sufficient statistical power to suggest a difference between verum and sham.

  18. See studies listed in footnote 19 as well as http://www.gerac.de/deu/pdf/5ErgebnisseinZahlen.pdf.

  19. See Vas et al. (2004), Vickers et al. (2004), and Furlan et al. (2005).

  20. See http://www.akupunktur-aktuell.de/2005/beitrag/01-20-1.htm.

  21. I have left out the extensive comments on the translation by Harper. The numbers in the first citation stand for lacunae in the original manuscript. There is controversy about the question which of these two texts represents the oldest attested stage of vessel theory and whether between them a developmental progression has taken place. See Harper (1998: 89–90).

  22. This textbook had an enormous influence on the Western reception of acupuncture in the era after the process of systematization and standardization that started in the 1950s. It served as reference work for teaching and translation into many other languages. The German standard textbook on acupuncture Quintessenz der Chinesischen Akupunktur und Moxibustion. Lehrbuch der chinesischen Hochschulen für Traditionelle Chinesische Medizin is a literal translation of this work. See Wühr (1988).

  23. The numbers in the text refer to a chart that illustrates the described pathway. The pinyin names followed by U.B.xx are the Chinese and international names of acupuncture points.

  24. From a psychophysiological point of view, the needle stimulus is a stressor for the patient, owing to its usually painful character. This evokes a distinct increase of sympathetic nerve activity during needling and a sympathetic withdrawal after the needling as has been shown by Ernst and Lee (1986) and Bäcker et al. (2002).

  25. De qi literally translated means receiving qi. It is a distending sensation or a sensation of numbness or flow of “energy” that is felt by the patient upon insertion and manipulation of the needle.

  26. Translated from Huangdi Neijing Suwen jiaoyi ( 1982: 352–355).

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Acknowledgments

I am indebted to Mrs. Arielle Rittersmith, Dr. Elisabeth Hsu, and Prof. Gunnar Stollberg for their editing and comments on this manuscript.

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  1. Lehrstuhl für Naturheilkunde, Kliniken Essen Mitte, Knappschafts-Krankenhaus, Universität Duisburg-Essen, Innere V, Am Deimelsberg 34a, 45276, Essen, Germany

    Iven Francis Tao

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Tao, I.F. A Critical Evaluation of Acupuncture Research. East Asian Science 2, 507–524 (2008). https://doi.org/10.1007/s12280-009-9070-0

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