Medical research and scientific evidence allow us to speak of and practice evidence based alternative medicine. Here we present most of the acupuncture research and chinese herb research for effectiveness and safety as well as some alternative medicine statistics.

NOTE: For the most recent and accurate information, also see these resources:

• Biomedical Mechanisms of Acupuncture
• Acupuncture Safety
• Acupuncture Statistics
• Acubriefs.com, the largest repository of acupuncture research online
• Qi Controversy: What is Qi?
• More Qi Controversy: Opposing Viewpoints on Qi

This article came out of a dispute I had on the radio with a Christian former new-ager named Marcia Montenegro (and which also led to another web site of mine, ChristianAcupuncture.com).

Some of the criticisms quoted are hers, others are standard claims made by skeptics. The original criticisms are in italics and marked with 'SKEPTIC.' Some of these are numbered to make the responses more specific and clear. Everything is linked for your convenience.

Table of Contents by Topic:

1. The definition of alternative medicine is discussed
2. Research standards and their application to Acupuncture
3. The First RCT faithful to both CM diagnosis and treatment and research standards
4. Acupuncture is proven by research to work for musculoskeletal conditions, such as fibromyalgia, myofascial pain, and tennis elbow, or epicondylitis, acupuncture is efficacious for adult postoperative and chemotherapy nausea and vomiting, postoperative dental pain, menstrual cramps, breech presentation in late pregnancy, irritable bowel syndrome, asthma, immune-system problems, severe vomiting during pregnancy, and cocaine dependence
5. The myth that substantial research evidence supports conventional medical practices is debunked
6. Acupuncture is safe, often safer than standard acceptable medical procedures
7. Fewer malpractice claims are filed against acupuncturists
8. A study of 55,000 acupuncture treatments showed 99.9% safety
9. Some safety issues of biomedicine are reviewed for comparison
10. Explanation of benefit-risk
11. Adverse drug reactions
12. Drug misadventures
13. RCT defined
14. Evidence of the biomedical mechanisms of acupuncture
15. The placebo effect being responsible for acupuncture's success debunked by another RCT
16. Response to inflammatory statements about acupuncturists being irrational, anti-science, conspiracy-oriented, and biased
17. A bad study design reviewed
18. History of TCM
19. Patient Demand, Doctors deceived?
20. Clarification of yin, yang, and qi
21. A possible reason for all the disagreement and confusion, and some perspectives on qi
22. Perspective on Acupuncture from Andrew Fergusson, the General Secretary of Christian Medical Fellowship
23. Is CM a medicine or a metaphysical system?
24. Spiritual aspects of CM, a harmonious-with-the-Bible example
25. Good and evil
26. More about qi
27. More about yin and yang
28. Meridians/channels

SKEPTIC: Alternative/Blended/Complementary/Integrated Healing
(1) It is called alternative because the technique/drug/herb (1a) has not been or (1a) cannot be adequately tested, or has been found (1c) ineffective or dangerous. (2) If it were a safe, tested treatment, it would not be in the alternative category.

RESPONSE:1. This is an inaccurate definition of alternative medicine. "There is no alternative medicine. There is only scientifically proven, evidence-based medicine supported by solid data or unproven medicine, for which scientific evidence is lacking." - Phil B. Fontanarosa, MD; George D. Lundberg, MD, The Journal of the American Medical Association, 1998. The section on RCT's provides the scientific proof, the evidence for acupuncture.

* "CAM (Complementary and Alternative Medicine) covers a broad range of healing philosophies (schools of thought), approaches, and therapies that mainstream Western (conventional) medicine does not commonly use, accept, study, understand, or make available." - from the National Center for Complementary and Alternative Medicine (NCCAM); - What is NCCAM? See the glossary for more info.

* Quick Quote: A PCOM professor who is an ER Doc (MD) says western medicine should be called alternative, because oriental medicine is preventive, and if you don't live preventively, the alternative is emergency intervention, often late in life.

1a. NIH Research Standards 1997: "The incorporation of any new clinical intervention into accepted practice faces more scrutiny now than ever before. The demands of evidence-based medicine, outcomes research, managed care systems of health care delivery, and a plethora of therapeutic choices make the acceptance of new treatments an arduous process. The difficulties are accentuated when the treatment is based on theories unfamiliar to Western medicine and its practitioners. It is important, therefore, that the evaluation of acupuncture for the treatment of specific conditions be carried out carefully, using designs that can withstand rigorous scrutiny." - Bensoussan and others' 1998 IBS RCT was believed to be "the first to incorporate traditional Chinese diagnosis and treatment methods for IBS into a strictly controlled, conventional study model."

1c. The Effectiveness of Acupuncture (see RCTs below)

2. Is acupuncture safe?

* "One of the advantages of acupuncture is that the incidence of adverse effects is substantially lower than that of many drugs or other accepted medical procedures used for the same conditions. As an example, musculoskeletal conditions, such as fibromyalgia, myofascial pain, and tennis elbow, or epicondylitis, are conditions for which acupuncture may be beneficial. These painful conditions are often treated with, among other things, anti-inflammatory medications (aspirin, ibuprofen, etc.) or with steroid injections. Both medical interventions have a potential for deleterious side effects but are still widely used and are considered acceptable treatments. The evidence supporting these therapies is no better than that for acupuncture. In addition, ample clinical experience, supported by some research data, suggests that acupuncture may be a reasonable option for a number of clinical conditions. Examples are postoperative pain and myofascial and low back pain. Examples of disorders for which the research evidence is less convincing but for which there are some positive clinical trials include addiction, stroke rehabilitation, carpal tunnel syndrome, osteoarthritis, and headache. Acupuncture treatment for many conditions such as asthma or addiction should be part of a comprehensive management program." - National Institutes of Health Consensus Statement on Acupuncture, 1997

* Safety of Acupuncture in terms of Insurance Malpractice Claims, JAMA 1998: "In an analysis of data from malpractice insurers from 1990 through 1996, Studdert and colleagues18 found that claims against chiropractors, massage therapists, and acupuncturists generally occurred less frequently and usually involved less severe injury than claims against medical doctors." - Phil B. Fontanarosa, MD; George D. Lundberg, MD

* Frequency and Types of Adverse Events in 55,291 Acupuncture Treatments: (see table) This means 99.8% of acupuncture is performed with no significant minor adverse events; "During these 5 years, a total of 76 acupuncturists (13 preceptors and 63 interns) participated in the study, and the total number of acupuncture treatments was 55291. A total of 64 adverse events were reported and included 11 types of events... The most frequent adverse event was failure to remove needles after treatment; no sequelae occurred after removal of the needles. The second most common adverse event was dizziness, discomfort, or perspiration probably due to transient hypotension associated with the acupuncture treatment.... We may, therefore, reasonably conclude that serious adverse events in acupuncture treatment are uncommon in the practice of adequately trained acupuncturists... ." - Hitoshi Yamashita, Bac, Hiroshi Tsukayama, BA, Yasuo Tanno, MD, PhD, Kazushi Nishijo, PhD, JAMA

* 2 September 2001 Studies of safety of acupuncture in British Medical Journal; Details of 43 minor adverse events associated with 34 407 acupuncture treatments; 91 minor events in 31 822 acupuncture treatments; if combined with the other study above = total of 121,520 treatments with 198 minor adverse events (0.16% incidence), and no pnemuothoraxes (they are concluded to be "extremely rare").

* The most serious adverse events possible with acupuncture are pneumothorax (puncturing the lung) and septicemia (systemic infection of the blood by bacteria); "Instruction is given by both lectures and practical training and includes information about anatomically risky depth of insertion and use of aseptic procedure for puncturing... Most important, no serious events such as pneumothorax, spinal lesion, or infection were reported (my note: zero out of 55,291! But even just one would have meant only a 0.002% chance of these occurring)" - JAMA

The Safety of Acupuncture compared with that of Biomedicine:

• Antibiotic overuse leads to resistant super-bacteria ("The prevalence of antibiotic-resistant bacteria in Taiwan is due to the heavy use of antimicrobial agents in both animal husbandry and clinical practice over the past decades" - source) as well as intestinal flora imbalance (diarrhea, vaginal candidiasis) ("Antibiotic use is a short-term risk factor for symptomatic vulvovaginal candidiasis, either as a first episode or in the form of recurrence. Increasing duration of antibiotic use is directly related with an increased prevalence of Candida vaginal infection. " - source) ("The spectrum of diarrheal disease associated with antibiotic therapy ranges from antibiotic associated diarrhea and colitis, to the more severe pseudomembranous colitis, which is always associated with Clostridium difficile (CD)." - source)
• "No drug product is "perfectly" safe. Every single drug that affects the body will have some side effects. Since the FDA considers both the benefits and risks of all medications before approval, side effects are generally not serious. For every drug FDA approves, the benefits are balanced against its risks. In addition, FDA makes sure the labeling (package insert) outlines the benefits and risks reported in the tested population. You and your health-care provider should decide together if the benefits outweigh the risks for YOU. Talking about your medicines with your health-care provider is just as important and good for your health as a complete check-up and taking your medicine as directed." - FDA/CDER
• "The benefit-risk ratio weighs the benefits provided by a drug, versus risks or safety problems that may be associated with use of the drug. No drug can be considered to be totally safe. Drugs that are associated with more significant safety problems are expected to have sufficiently greater benefits to justify the increased risk." - source
• What does benefit-risk mean to us? A la a discussion of tamoxifen (a breast cancer drug): "there are categories that, from my perspective, clearly fall out where the benefits unequivocally outweigh the risks... I think physicians very frequently discuss risk-benefit ratios for all sorts of treatments, and it ultimately comes down to a decision between the patient and the doctor." - source

• NSAIDS such as ibuprofen - "Gastrointestinal (GI) Adverse Drug Reactions (ADRs) from the NSAIDs are a major cause of morbidity and mortality in arthritic patients taking these drugs... Clearly, the need to develop newer NSAIDs with lower risks of ulcers and bleeding as well as symptomatic ADRs is still representing a major challenge." - Jan 2001
• high dose steroid use (e.g. in asthma or COPD) leading "high dose of inhaled steroids may lead to adrenocortical suppression and hence estrogen deficiency in postmenopausal women," "the daily dose, but not the duration, of inhaled steroid therapy may adversely affect bone density"(osteoporosis), "The potential risks of antiasthmatic inhaled steroid therapy are essentially dose-related and include oropharyngeal complications such as thrush and dysphonia, and systemic complications such as hyperactivity, behavioural change, hypothalamic-pituitary-adrenal axis suppression, facial and weight changes characteristic of hypercortisonism, cataracts, increased intraocular pressure, dermal atrophy causing steroid purpura, retarded growth in children and osteoporosis. A few cases of fracture or acute adrenocortical insufficiency have been reported."

Drug Misadventures: "Still, we know from studies published to date that drug misadventures account for: 8-10% of admissions of patients to hospitals, 25% of admissions to hospitals by persons age 65 years of age or older, 10-15% of visits to emergency rooms in some urban settings, 4.5 drug order errors per 1000 drug orders in hospitals, Significant decreases in the quality of life (due to inappropriate prescribing, e.g., of hypnotics for the elderly), 2 in 1000 deaths in hospitals, and Deterioration or destruction of specific organs." - source

SKEPTIC: (3) Many cited studies to support these methods are flawed, short-term, based on anecdotal evidence, (4) conducted by believers in the techniques, & (5) often are not published in a peer-reviewed medical journal. (This section deals with the evidence for the efficacy of acupuncture, and the quality and amount of the research as of November, 2001; many skeptics' criticisms are based on the state of research as of 1997.)

RESPONSE: 3. Define RCT - Randomized Controlled Trial. The RCT "is widely regarded as the most powerful and sensitive tool for comparing therapeutic interventions.85" As for RCTs and acupuncture, even 4 years ago (1997), experts from various fields including MD's, PhD's, and acupuncturists reviewed the evidence and made what was called the National Institutes of Health Consensus Statement on Acupuncture - "There is clear evidence that needle acupuncture is efficacious for adult postoperative and chemotherapy nausea and vomiting and probably for the nausea of pregnancy. Much of the research is on various pain problems. There is evidence of efficacy for postoperative dental pain. There are reasonable studies (although sometimes only single studies) showing relief of pain with acupuncture on diverse pain conditions such as menstrual cramps, tennis elbow, and fibromyalgia. This suggests that acupuncture may have a more general effect on pain. However, there are also studies that do not find efficacy for acupuncture in pain."

* From same source, we see that even biomedicine (drugs and surgery) is not held to the same standards to which skeptics want to hold acupuncture: "While it is often thought that there is substantial research evidence to support conventional medical practices, this is frequently not the case. This does not mean that these treatments are ineffective."

* There was no such thing as RCT's in 4500 year history of CM, and there has only been adequate funding sources for this for 4 or 5 years.

Acupuncture RCT's are underway for:

• Hypertension
• Chronic diarrhea in HIV patients
• Fibromyalgia
• Depression
• Knee Osteoarthritis
• Dental pain

* 1998: "University of California Irvine professor and physicist Zang-Hee Cho, a member of the highly respected National Academy of Science, the inventor of an early version of the Positron Emission Tomograph, or PET scan, and a pioneer of the MRI scanner, both of which have revolutionized our ability to see into the body and brain, found that stimulation of the vision-related acupoint showed the same reaction in the brain as stimulation of the eye. As the acupuncture signal passes to the brain via nerves, it possibly stimulates the hypothalamus, the "executive center" of the brain, responsible for the production and release of hundreds of neurochemicals, Cho said."

* 1998 research from the Journal of the American Medical Association: "Cardini and Weixin found that moxibustion (stimulation of an acupuncture point by heat generated from burning a specific herb) is helpful for correction of breech presentation in late pregnancy. Bensoussan and colleagues document that a Chinese herbal medicine formulation improves symptoms of irritable bowel syndrome."

* 2000 randomized controlled study showed "asthma patients benefit from acupuncture treatment given in addition to conventional therapy. Furthermore, acupuncture performed in accordance with the principles of TCM showed significant immune-modulating effects."

* "This study suggests that active PC6 acupuncture, in combination with standard treatment, could make women with hyperemesis gravidarum (severe vomiting during pregnancy) better faster than placebo acupuncture."

* "Findings from the current study suggest that acupuncture shows promise for the treatment of cocaine dependence. Further investigation of this treatment modality appears to be warranted." -

* Cytology of acupuncture points

* Enkephalins vs endorphins

4. The point of doing RCT's is to eliminate subjectivity- you can't also ask that the studies be performed only by people who think acupuncture doesn't work- generally, the people interested in doing research on something are the ones who are experts about it. Most of the pharaceutical research is done not only by believers in the drug, but by the very corporation who will benefit from its sale, but this fact does not invalidate the conclusions of their RCT's.

5. Actually, this is not true at all. Many studies of various types have been published in peer review journals over the years. We must expand upon what you mean by 'peer' - literally, for acupuncturists, it would mean acupuncturist-reviewed acupuncture journals (for example). But plenty of RCT's have been published in medical journals (such as the Journal of the American Medical Association) as well. The terms complementary, blended, and integrated are now being used as well since alternative treatments are being combined with traditional medicine. This makes it more difficult to test the alternative methods or to know what is really working when the patient improves. This is true clinically just as much for biomedical practitioners as acupuncturists - real patients are affected by many factors including environment, drugs, genetics, supplements, etc. This is another reason for RCT's. The following studies on the biomedical mechanisms of acupuncture may also help you.

Biomedical Mechanisms of Acupuncture

* 1997 NIH statement: "Many studies in animals and humans have demonstrated that acupuncture can cause multiple biological responses. These responses can occur locally, i.e., at or close to the site of application, or at a distance, mediated mainly by sensory neurons to many structures within the central nervous system. This can lead to activation of pathways affecting various physiological systems in the brain as well as in the periphery. A focus of attention has been the role of endogenous opioids in acupuncture analgesia. Considerable evidence supports the claim that opioid peptides are released during acupuncture and that the analgesic effects of acupuncture are at least partially explained by their actions. That opioid antagonists such as naloxone reverse the analgesic effects of acupuncture further strengthens this hypothesis. Stimulation by acupuncture may also

• activate the hypothalamus and the pituitary gland, resulting in a broad spectrum of systemic effects
• Alteration in the secretion of neurotransmitters and neurohormones and changes in the regulation of blood flow, both centrally and peripherally, have been documented.
• There is also evidence of alterations in immune functions produced by acupuncture. Which of these and other physiological changes mediate clinical effects is at present unclear."

* From the same source: "Findings from basic research have begun to elucidate the mechanisms of action of acupuncture, including the release of opioids and other peptides in the central nervous system and the periphery and changes in neuroendocrine function. Although much needs to be accomplished, the emergence of plausible mechanisms for the therapeutic effects of acupuncture is encouraging."

* One of the studies cited by the NIH was conducted by Abass Alavi, M.D., chief of nuclear medicine at the University of Pennsylvania Medical Center, who showed that acupuncture affects the flow of blood in the brain. He used SPECT (single photon emission computed tomography) to view the brains of four people with pain and five pain-free people who served as the control group. Dr. Alavi found that after acupuncture needles were inserted, all of the patients had increased blood flow to the thalamus, the area of the brain that relays pain and other sensory messages. Because the brains of the pain-free group showed the same reactions as those with pain, the changes in blood flow couldn't be attributed to placebo.

* "The phenomenon of acupuncture is both complex and dynamic. Recent information demonstrates that acupuncture may exert its actions on pain and immune processes. The coupling of these two systems occurs via common signaling molecules, i.e., opioid peptides. In this regard, we surmise that

• opioid activation leads to the processing of opioid peptides from their precursor, proenkephalin, and
• the simultaneous release of antibacterial peptides contained within the precursor as well. Thus,
• central nervous system pain circuits may be coupled to immune enhancement.
• Furthermore, acupuncture needle manipulation elicited signal increases bilaterally in the region of the primary and secondary somatosensory corticies in human brain as determined by magnetic resonance imaging.
• The maps reveal marked signal decreases bilaterally in multiple limbic and deep gray structures including the nucleus accumbens, amygdala, hypothalamus, hippocampus, and ventral tegmental area.
• Taken together, we surmise a major central nervous system pathway as well as local pain and immune modulation during acupuncture." - 1999 Review

* "In recent years, more and more laboratory proof has accumulated that acupuncture can

• change the charge and potential of neurons,
• the concentrations of K(+), Na(+), Ca(++) and
• the content of neuro-transmitters such as aspartate, and taurine and
• the quantities of neuro-peptides such as beta-endorphin and leu-enkephalin.
• All these phenomena are directly related to nerve cells." - source

SKEPTIC: It should be remembered that the placebo effect accounts for 30% or more for a person feeling better.

RESPONSE: Only 1/3 of people respond to placebo treatment, but "Both animal and human laboratory and clinical experience suggest that the majority (more than half) of subjects respond to acupuncture, with a minority not responding" - source

* One primary reason for doing RCT's is to eliminate the influence of the placebo effect. Again, I refer you to the published RCT's on acupuncture mentioned above.

* I challenge you to explain how the placebo effect is working in a dog or cat who is healed by acupuncture- we can't tell them what to expect, etc. Here is an RCT that shows significant success with hind-limb paralysis in dogs

SKEPTIC: (1) Proponents of alternative medicine are often hostile to the medical establishment and/or (2) what is called "western thinking," that is, rational thinking. There is often a bias against science or (3) belief in a conspiracy amongst physicians. (4) This prejudice prevents them from objectively viewing the evidence against alternative healing.

RESPONSE: Some of this language (the words chosen: hostile, rational, conspiracy, prejudice) is quite inflammatory. I will address these point by point.

1. Hostility is ill-will; do acupuncturists have ill-will toward the medical establishment? And what is the medical establishment? According to some MD's, it would not include chiropractic. It depends upon who you talk to. And if you talk to other MD's, you will find that they are themselves hostile to the current economic climate in medicine. Also, there are alternative medicine programs at highly-regarded medical universities, such as Harvard (the top medical school in the U.S.). Back in July 11, 2000, Harvard Medical School established the Division for Research and Education in Complementary and Integrative Medical Therapies. One of the best known names in acupuncture, Ted Kaptchuk, is Associate Director of the Center for Alternative Medicine Research at Harvard Medical School, and an Assistant Professor of Medicine at Harvard Medical School. For a study by Harvard Medical Researchers that shows that CAM is here to stay. My point is that there is no homogenous medical establishment against which to hold ill-will, and given the acceptance of CAM by leaders within the various sectors of health care (education, insurance, journalism, clinical), there is no need for such ill-will. The current healthcare model is called cooperative care, in which practitioners of various types of medicine cooperate around a primary care provider in the care of individual patients.

2. This is an interesting claim, that alternative medicine practitioners are irrational, and can't or don't want to think logically. I almost would rather not answer it until the critic gives me some indication of their source for this idea. But I will anyway:

* There are people in every profession who have varying degrees of logical and critical-thinking ability. M.D. programs, with their rigorous scientific and mathematic requirements and education, do tend to produce more logical, critically-thinking practitioners. The national requirements for graduation and licensure in OM are: "graduation from a formal full-time acupuncture program that can document at least 1,725 hours of entry-level acupuncture education. Education must consist of a minimum of 1000 didactic and 500 clinical hours." The educational standards have been raised quite a bit in the last 5 years. In fact, newly graduated acupuncturists and those who have been in practice for 5-10 years are almost different breeds. In the same way that MD programs are including CAM programs, schools like the Pacific College of Oriental Medicine (San Diego, CA) are integrating biomedicine into their curriculae. One aspect of PCOM's curriculum is the 10-class Oriental Medicine series, which is divided by specialty (e.g. gynecology, psychology, neurology) and in which 25% of the material is biomedical. Acupuncturists are taught what conditions to treat and what not to treat, when to refer out, and when to send a patient to the ER. The profession currently developing a Ph.D. track which will include specialization and research. This will increase the education from 4 graduate years to 6 graduate and post-graduate years.

* My personal experience of acupuncturists is that although some of them are pretty right-brained, there are a lot of very smart, analytical, critical thinkers in oriental medicine- some of these are are doing or planning to do research.

* There are is also a sub-population of acupuncture academicians (for example, Nigel Wiseman, Bob Flaws, Min Fan, Bob Damone) who focus on translating and studying both classical chinese medical texts and current research from chinese medical journals. Translation requires a high level of academic proficiency, intelligence, and rational and critical thinking. Inherent to all understanding and practice of chinese medicine are the skills of inquiry, observation, analysis, comparison, and synthesis (the latter 3 of which require rational/critical thinking).

* What is the essence of science? The scientific method is: look at the situation, come up with a theory, test it, then assess whether you got it right or you need a new theory. The history of chinese medicine is the application of the scientific method to real life situations- as I have said, there was no RCT for thousands of years - either it worked clinically (and the socio-economic climate for doctors was such that their welfare and very lives depended upon success), or it didn't. Only in the last 50-100 years, has western medicine has become so technology based, and CM has been present in the western world for a century or less. The standards of biotechnology now require the justification, integration and reinterpretion oriental medicine from a biomedical point of view. And it's a good thing, because no medicine is perfect- they learn from one another- many pharmaceuticals, such as aspirin, come from herbs utilized historically in traditional medicines- and the RCT, as long as the funds are available, will help oriental medicine clarify some of its areas of internal disagreement.

3. One must be very careful in their response to an accusation of belief in conspiracies. This kind of accusation is a powerful way to discredit your opponent by making them appear paranoid and irrational. In responding to this, anything I would say about physicians disagreeing with any aspect of CAM would confirm the suspicion of paranoia. After reviewing some of the information on the web about conspiracies and medicine, I would rather not get into the topic. It is not my desire, nor in the acupuncture profession's or the patients' interests for us to get into wildly speculative discussions. Let's stick with RCT's, retrospective studies and reviews, and study of chinese classical and modern sources.

4. As far as the evidence against alternative medicine, I'm not sure what you mean. It is true that some studies are showing minimal or only short-term efficacy (as in neck pain), but I still need to review the quality of the study designs (although in the neck pain study, the design was good). For the most part the criticisms leveled are based upon our lack of proof not that it works, because more and more of that has been proven, but in terms of how it works in biomedical terms. As I mentioned, there has been no need for that kind of justification or argument for thousands of years, and only in the last 5 years have we been given the kind of funding necessary to gather that data. There are trials that show acupuncture now to be effective for one condition or another; this is a complex issue, because all RCT's need to be reviewed and designed to be true to chinese medical diagnosis and treatment. One trial I reviewed of acupuncture for Rheumatoid Arthritis concluded that "Acupuncture of this type cannot be considered as a useful adjunct to therapy in patients with RA," but "acupuncture of this type" is "single-point (Liver 3) acupuncture." There is, among some acupuncturists, a belief that the superior acupuncturist could choose the one most appropriate point for a patient, but this point would be selected on an individual basis and never in such a general way as in this study (only one specific point for a western disease). In addition, Liver 3 is a poor choice for one point to use for RA. In discussion of related problems in the classical literature (see list of acupuncture reference texts at end of document), many of the 360+ acupuncture points are mentioned, but never Liver 3. To be faithful to CM, patients would have to be divided in to diagnostic sub-groups (divided by criteria such as the location of the RA), and then treated. So this study is correct in saying that that type of acupuncture is not useful, but it does not prove whether or not proper classical acupuncture would be effect for RA. As mentioned above, the 1998 Bensoussan study may have been the first RCT to be true to Chinese Medicine.

History of Chinese Medicine

Chinese medicine was almost destroyed by the communists in the 1950's (who wanted to modernize medicine in their country), but Mao Tse-tung developed bell's palsy (a sometimes self-limiting, sometimes permanent neurological facial paralysis with which acupuncture has a high cure rate); being cured by acupuncture convinced him to keep CM- he ordered that it be systematized and simplified into what is known as TCM (Traditional Chinese Medicine). As we know, the communists are atheists; in creating the TCM version of CM, they stripped away any remaining metaphysical aspects. Isn't it ironic that the atheistic communist chinese did Christians a service by eliminating any potentially contradictory metaphysical beliefs from this traditional medicine?

* It only came to the U.S., really, in the 1970's, about the time when western medicine was discovering the immune system- CM has dealt with its own conception of the immune system for thousands of years. In fact, the western science of psychoneuroimmunology is the closest one to explaining and being informed by the theories and mechanisms of acupuncture.

SKEPTIC: More doctors are now allowing or advocating these treatments because of patient demand so they can stay in business. But remember, doctors can be deceived, too.

RESPONSE: There is patient demand because for many illnesses, there are not great western medical treatments; either

• the pharmaceuticals have too many or too severe side effects, or
• the risks of tx with pharm or surgery are too high and 'nothing can be done,' or
• there are only palliative (symptom-relieving) or
• no known effective western treatments (e.g. IBS)

* In some of these conditions, chinese medicine is effective even if just in relieving symptoms without causing side-effects (generally the only serious risk of acupuncture is a pneumothorax, which are quite rare and basically impossible if the acu has been trained and licensed in accordance with state and national laws, and proper herbal treatments are personalized to prevent side-effects- see the safety section)

* Anyone can be deceived- not sure what to say about that- that is probably true... but so what? That doesn't prove that there is a deception here. I will again refer you back to the RCT's and reviews above.

SKEPTIC: Many of the new healing techniques are being called energy medicine since there is an assumption that one is dealing with channeling, transferring or altering energy. This energy is not measurable or biological; it is believed to be the energy of a universal force/life force pervading all. The belief in this type of energy is foundational for sorcery, pantheism, monism, some Eastern religions, many New Age-related beliefs, and most of the occult. Sometimes this energy is seen as being an impersonal God, a god-force, or an innate divine intelligence which infuses all parts of the universe and our bodies. These are spiritual, not medical, views.

RESPONSE: Skeptical views of OM and acupuncture often focus on whether or not yin and yang and qi actually exist. Let's end that debate right here - the truth is, they do not. That is not central to Chinese medicine. Those concepts are parts of theories (a la scientific method) that attempt to explain why acupuncture and chinese herbal medicine work, and how they can work better- it is clear that the system is not complete or perfect, or else it would always work... like many things in this world, it is a work in progress. Theories can be discarded for new ones. The entire system of chinese medical theory may one day be discarded once an integrated biomedical understanding of these mechanisms is assembled.

The Reason for All the Confusion? It is possible that the heterogenous, multi-traditional, overlapping, organic, complex nature of chinese medical theory, which leads to disagreements between and different representations from CM practitioners, confuses both the public and other medical practitioners.

* Some scholars of oriental medicine now believe that the translation of 'qi' as 'energy' (which came from Morant in the 1930's) is inaccurate. It is also translated as 'breaths,' or 'vital air.' It must be remembered that this all comes from the chinese language which is composed of characters that are basically simplified drawings of real objects- so the character for 'qi' is the steam coming off a pot of rice. How we interpret that, whether it is properly interpreted or not, is still up for grabs. Reading the Bible is similar- the original was written in Greek and Hebrew, and often, the words are translated differently in different versions (KJV, NIV, RSV).

* We do know from MRI studies that the nervous system is activated by acupuncture- but in biomedical terms, qi could be related to so many things (oxygen, carbohydrates, proteins, synaptic transmission), that it becomes clear that oriental medicine, like the Chinese language itself, is largely metaphorical (symbolic, like the analogies called parables that Christ used to teach)- it is to some degree mechanical, but nowhere near as much as biomedicine is, and how could it be, without microscopes, autopsies, MRI's, and lab tests? None of those tests were available for thousands of years of CM.

The Christian Medical Fellowship: "When CMF's Medical Study Group investigated acupuncture in the mid-1980s, we quizzed Dr Felix Mann, then Britain's best known practitioner and the person chiefly responsible for introducing acupuncture into clinical practice in the UK. He denied holding a religious faith himself, and he put no weight on the claims of Yin-Yang theories. Dr Mann believes the ancients stumbled upon something that worked empirically, needed (as human beings always do) an explanation for this, and therefore expressed their understanding in the terms of their own cultural beliefs. He sees the methodology as having limited but definite benefit (and he was refreshingly sceptical about how close you have to get the needle to the 'acupuncture points') and sees no need to invoke any mystical or spiritual explanations. I found his healthy common sense convincing. Conclusion: the methodology works, sometimes. We do not need to invoke spiritual principles." - Andrew Fergusson is the General Secretary of Christian Medical Fellowship

* "Does the therapy involve the occult? I should by now have made clear that the therapy itself need not involve the occult, but let me now emphasise the most important warning in this article: while the therapy might not involve the occult, the therapist might! As with most if not all alternative practices the question is not so much about the nature of the therapy, but about the nature of the therapist. Who is this person I am about to place myself under? In all therapeutic relationships, there is a power imbalance and the patient, the client, the counsellee, is potentially submitting to a lot when they place themselves 'under' the therapist. I am therefore in general more concerned about the acupuncturist in question than about the acupuncture. Let me give you an example. As General Secretary of CMF, I spoke once on the phone to a lay Christian, an ordinary person without any training or expertise in health matters. He told me how he had visited an acupuncturist in his village, and after half a dozen treatments he had indeed achieved relief of the chronic painful condition he'd first gone with. He put this down to the therapy (though I must say I wondered if the condition had got better anyway over the two month period in question!). But what he went on to say was concerning. He told me that while the acupuncturist was twiddling the needles he was always muttering something inaudible under his breath, in what sounded like an incantation. He noticed too that progressively over that two month period his own spiritual life had begun to dry up. He found it hard to pray, he lost interest in going to church, he lost some of his love for the Lord. Eventually he came to realise that perhaps he'd come under some harmful spiritual influence from the acupuncturist. Simple repentance and prayer was immediately completely effective in restoring his spiritual life. I have heard a few other anecdotes like that. I don't necessarily believe every element, but I take them seriously. Conclusion: acupuncture need not involve the occult, but the acupuncturist might!" - Andrew Fergusson is the General Secretary of Christian Medical Fellowship

Is CM a medicine (are its views medical or spiritual?): Definition: med·i·cine (md-sn) n. 1. a. The science of diagnosing, treating, or preventing disease and other damage to the body or mind. b. The branch of this science encompassing treatment by drugs, diet, exercise, and other nonsurgical means. 2. The practice of medicine. 3. An agent, such as a drug, used to treat disease or injury. 4. Something that serves as a remedy or corrective: medicine for rebuilding the economy; measures that were harsh medicine.

* CM does diagnose (see Bensoussan's 1998 study of IBS), treat, and prevent disease and damage to the body and mind. And thousands of years of anecdotal evidence, and recent scientific research supports this. Herbs are agents used to treat disease and injury, so they are medicines. So the system of medicine that applies acupuncture and herbal medicine does have medical views.

BUT Chinese Medicine has spiritual views, too, and that is where it gets tricky to reconcile with Christianity. This is a broad topic that I am still researching, and it will probably take me a couple years to get through all the classical chinese medical literature and the Bible and related commentaries, but one thing I have found already might serve as an example of where they agree: In Biblical language, according to my NIV study bible, the word 'heart' means the center of one's being including mind, will, and emotions. Now, in western medicine, the heart is just an organ that pumps the blood through the body. But in CM, the heart is the central authority and consciousness in terms of mind, emotion, and being. It is our connection to heaven. In CM, also, the 'sprout' of the heart is the tongue and expresses our consciousness, much as Jesus said in Mat 12:34, "out of the overflow of the heart, the mouth speaks," and 15:18, "the things that come out of the mouth come from the heart." Unlike western medicine, CM never separated mind, emotion, body, and spirit in its theory, diagnosis, and treatment. There is much more that can be said about the Heart, but that is another topic. Untangling the complex meanings of statements about the spiritual from many classic CM sources and reconciling them with Christian Biblical truth is a huge project- I cannot say much more at this point.

Good and Evil: It is interesting to note that the earliest acupuncture grew out of a tradition of shamanistic attempts to get rid of evil spirits. Early acupuncture utilized some points and herbs to expel demons. Whether the problem was actually a demon, or a neurochemical imbalance, or something else is an academic point which needs further study, but it places chinese medical tradition spiritually on the same side of the fence with Christianity as a viewpoint that, as opposed to new-Age thought, acknowledge both good and evil in the universe. Many techniques such as acupuncture, acupressure, tai chi (not a medicine but often prescribed for people recovering from illness) are based on the belief that a universal force called chi (also spelled as qi, ki or ji) which pervades everything and everyone must be flowing to achieve good health.

More About Qi: As stated above, understanding qi is a matter of interpretation of the Chinese characters. This is a metaphorical language; please re-read that section above. As far as whether qi pervades everything, I do not believe that is an accurate representation of chinese medical theory. Qi can mean many different things in different contexts; air, gas, vapor, flatus, smell, environmental influences, character, breath, circumstance, activity, defense, containment, strength, transformation, disease; but I believe the idea that qi pervades everything is actually a non-traditional new-age idea grafted onto chinese medicine. (There are actually quite specific ways in which qi enters the body or is formed (through food or air intake), and how it moves to defend the body from attack (the wei qi or immune system)). This is the kind of thing that disturbs me. No matter what additional research should be done in regard to acupuncture, and what questions can be raised, it's clear that it has many good effects and insights, and not only should we not allow the new-agers to claim it as their own, but also we should keep it pure, we should be clear about what really is oriental medicine and what isn't.

* As far as qi goes, in CM metaphorical terms, yes, if qi does not flow, there is stagnation, and that often causes symptoms like pain, intestinal gas, anger, etc. There can also be qi deficiency, which manifests as fatigue, loose stool, low appetite, etc. There is also the belief in two universal energies, yin and yang, which must be balanced. If anything is blocking the chi or unbalancing the yin and yang, then illness results. The chi is believed to flow through invisible channels in the body called meridians.

More About Yin and Yang: Yin and yang are not energies or forces. They are descriptors ... more like adjectives than nouns (although they are used as nouns when speaking metaphorically about physical or mental tendencies, activities, or potentials). I knew I was going to have to write an article about this one for Christians. Misunderstanding yin and yang, qi and meridians as real forces is akin to the disciples' and others' frequent literal/material misunderstanding of Jesus' parables. They are used to categorize things into their opposites. For example, cold is more yin than heat is. Heat is more yang than cold is. We can say that yin is evil because it is associated with darkness, but that would be inaccurate- the darkness referred to is what we see with our eyes, not a spiritual or emotional 'darkness.' Neither yin nor yang are essentially anything, except in comparison to one another. Good and bad, active or passive, male or female... there are many things that happen normally in the body (physiology) described by CM in terms of yin and yang. For example, qi is relatively yang compared to substance which is more yin. So when you move one of your muscles, you have activated (yang) the nerves in your muscles (yin) by way of your desire (yang) to move (yang) them. Hope that helps explain that we don't really believe there are independent forces or entities called yin or yang- we don't think we'll see them on an MRI... but we could say that an MRI is a yang method of seeing internal activities (yang) and substances (yin).

Invisible channels/meridians: Again, I must emphasize the metaphorical nature of chinese medical theory. And refer to the work of Dr. Zang-he Cho, which proves via MRI, a credible, objective biomedical visual imaging technique that acupuncture points can stimulate aspects of the CNS without direct neural connection- this implies that the nervous system is more complex than we know and that acupuncture works via some computer-like code interpretted by the brain. It would mean that the map of the body described by CM's system of meridians probably is accurate in terms of the correspondences it suggests- that, e.g., the points on the foot from the discover article are on a meridian connected with the eye, telling us that altho there may be no neural connection between the foot and the eye, there is a relationship that the CNS can understand and act upon.

SKEPTIC: (1) In this case, treatment is based on a spiritual belief system, not on medicine or scientific fact. (2) So far (as of 3/2000), no medical or biological basis as been discovered for acupuncture. (3) There are theories that the needles trigger the release of endorphins, causing a temporary relief of pain.

RESPONSE: (1) At this point in the article, it should be well-established by now that CM is medical, not spiritual

(2) Untrue back then, and certainly untrue in the light of subsequent research. The biomedical mechanisms of acupuncture according to scientific research are reviewed above.

(3) Endorphins: Actually, the mechanism of pain relief is much more complex, and is discussed above under the biomedical mechanisms of acupuncture.