Anthony Campbell

Point specificity of acupuncture in the light of recent clinical and imaging studies

One fundamental question that is still not resolved is whether acupuncture needles must be inserted in specific points to have their greatest effects. In the majority of large RCTs recently conducted in Germany, acupuncture was significantly more effective than doing nothing but not than sham acupuncture. Only for one study of chronic knee pain was acupuncture superior to sham. Brain imaging with functional magnetic resonance (fMRI) and positron emission tomography (PET) may be helpful but is still in its early stages. Several studies have shown differences between the way the deep central areas of the brain respond to genuine acupuncture compared with sham. Acupuncture can clearly produce complex changes that are relevant to pain transmission and perception, though it is still uncertain how specific these are. Similar changes have been seen after the application of placebo cream and after hypnosis. A previous paper discussed the likely central role of the limbic system in acupuncture, evidenced by euphoria and out of body experiences. There may be a good deal of common ground between acupuncture, placebo treatments, hypnosis, and even manipulative treatments. This understanding could offer a way out of the sterile debate about whether acupuncture is merely a placebo: acupuncture could be one effective way of stimulating responses within these deep areas of the brain, though not the only way.

The limbic system and emotion in relation to acupuncture

Patients receiving acupuncture sometimes manifest phenomena such as laughter or crying; varying degrees of relaxation or euphoria are quite common. Rarely, epileptic fits occur. Patients vary considerably in their responsiveness to acupuncture: some fail to respond at all while others (strong reactors) experience marked effects. It is widely recognised that fear of acupuncture generally precludes a therapeutic response, whereas belief in the efficacy of the treatment is irrelevant. All these phenomena must presumably have a neurophysiological explanation. This paper proposes that they may, at least in part, be caused by processes occurring in those brain structures that are classified as forming the limbic system. The paper briefly reviews the history and status of the limbic system idea, discusses how limbic system structures may contribute to the phenomena in question, and offers a number of predictions which would allow these hypotheses to be tested.

Role of C tactile fibres in touch and emotion – clinical and research relevance to acupuncture

Acupuncture is generally thought to rely on Aδ fibre stimulation for its effects and the role of C fibres has been largely discounted. Recent research, however, shows that there are C tactile fibres in humans that respond to light touch and project to the limbic system. They are thought to be responsible for feelings of calm and wellbeing that are elicited by gentle manual stimulation, as in stroking. These findings are likely to be relevant to acupuncture as regards both clinical practice and research. They may explain why even superficial acupuncture with brief needle insertion can have a clinical effect and why light touch may not be an adequate control procedure for use in clinical trials.

Acupuncture: Where to Place the Needles and for How Long

There are many ways of choosing positions on the body to needle in acupuncture treatment. Similarly there are many ways of stimulating the points chosen. Despite the variety of acupuncture methods advocated, most good-quality trials seem to show a similar 70% success rate, suggesting that there is little clinical difference between techniques. In order to simplify the Western medical usage of acupuncture, the author offers a composite view of needling techniques in which the term “Acupuncture treatment area” (ATA) refers to any suitable site of needle insertion. This may be a single traditional point, it may be a local painful area, a distant strong point, the periosteum around a joint, or it could be a large area of subcutaneous tissue, as in the lower abdomen. The author suggests that the concept of ATAs will allow acupuncture development free of theoretical expectations, and has the advantage that clinically most medical acupuncturists have already adopted this way of working.

Seeing the body: a new mechanism for acupuncture analgesia?

The use of visual illusions to study how the brain gives rise to a representation of the body has produced surprising results, particularly in relation to modulation of pain. It seems likely that this research has relevance to how we understand acupuncture analgesia. Acupuncture supplies several different kinds of signal to the brain: touch in the preliminary examination for tender areas; needle stimulation, mainly of Aδ fibres; and sometimes visual input from the patients sight of the needle insertion. In the light of recent research, all these are likely to modulate pain. There are implications here for clinical practice and for research. Acupuncture may be more effective if patients can see the needles being inserted. The use of non-penetrating stimuli to the skin or minimal needle insertion at non-acupuncture points as control procedures becomes more than ever open to question and this, in turn, has relevance for claims that acupuncture is indistinguishable from placebo.

Hidden assumptions and the placebo effect

Whether, or how far, acupuncture effects can be explained as due to the placebo response is clearly an important issue, but there is an underlying philosophical assumption implicit in much of the debate, which is often ignored. Much of the argument is cast in terms which suggest that there is an immaterial mind hovering above the brain and giving rise to spurious effects. This model derives from Cartesian dualism which would probably be rejected by nearly all those involved, but it is characteristic of “folk psychology” and seems to have an unconscious influence on much of the terminology that is used. The majority of philosophers today reject dualism and this is also the dominant trend in science. Placebo effects, on this view, must be brain effects. It is important for modern acupuncture practitioners to keep this in mind when reading research on the placebo question.

The art of medicine in early China: the ancient and mediaeval origins of a modern archive

Miranda Brown. Cambridge University Press, New York, 2015. 237pp. ISBN: 978-1-107-99705-6. ![Graphic][1] The title of this book may be slightly misleading, because, as Miranda Brown says at the outset, it is not about how medicine was practised in early China but about how the ancient healers have been understood in both Europe and China. From this one might think that the book would have little relevance for modern acupuncture practitioners, especially as there is little discussion of acupuncture specifically, contrary to what the cover illustration might suggest. That was my own initial impression, but further reading convinced me I was wrong. In the 20th century the main sources of information for Westerners interested in the history of Chinese medicine were the writings of Joseph Needham and Lu Gwei-djen. … [1]: /embed/inline-graphic-1.gif

The modernisation of acupuncture

Traditional ideas about acupuncture are popular today in the West, where their presumed antiquity is an important part of their appeal. Enthusiasm for acupuncture is often coupled with condemnation of the ‘reductionism’ that is supposed to characterise modern medicine. Yet present-day Chinese researchers often wish to reconcile acupuncture with science; it is notable how many papers from China are now appearing in the pages of Acupuncture in Medicine. This approach is quite similar to that advocated by Felix Mann in the 1970s, which essentially regards acupuncture as a form of sensory stimulation that modifies the activity of the nervous system and relies on a modern understanding of anatomy and neurophysiology.1 From this outline we see that there must have been a considerable shift in opinion in China in the fairly recent past. Hitherto there has been little information available to Westerners to explain how, when, and why this occurred. The gap in our knowledge has now been filled, thanks to a new book by Andrews,2 and the answers that she comes up with are surprising, to say the least. Anyone who thinks there was a more or less continuous progression in acupuncture from the earliest times to the present, perhaps with one or two temporary interruptions along the way, is in for a shock. What we see instead is a major discontinuity followed by a pretty radical reconstruction. Andrews is an associate professor of East …

Referred itch and meridians

I have thought for a long time that the phenomenon of referred itch (mitempfindung) might have relevance to acupuncture so I was delighted to see this paper. Silberstein has shown convincingly, albeit on a small number of cases, that the distribution of remote sensations in referred itch is remarkably similar to the location of certain paired channels in the traditional system.1 So what does this tell us? First, it reinforces what we already knew: the existence of this curious phenomenon must indicate the presence of connections in the nervous system, peripheral or central (or both), that are at present unknown. Whether or not this is directly relevant to acupuncture, it lends plausibility to the claim that inserting needles in various sites may have wide-ranging …