In fact, it is not the first time that acupuncture has been called a placebo. As early as 20 15, there was a great controversy about whether acupuncture was a placebo, and the discussion about it, or earlier, is still unknown. This time, a similar topic has been dug up, which is actually just a new speculation.
In this article, Netease described the tortuous development of acupuncture with pen and ink, and revealed all kinds of unknown secrets of acupuncture overseas. Finally, it uses a seemingly correct placebo double-blind experimental result in foreign journals, and finally draws a definite conclusion: the biggest role of acupuncture is to act as a placebo, and acupuncture is not only useless, but even harmful to human body.
But is acupuncture really just a placebo?
Not exactly.
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acupuncture and moxibustion
Acupuncture is divided into two methods, acupuncture and moxibustion.
Acupuncture means that under the guidance of the theory of traditional Chinese medicine, a needle (usually a filiform needle) is inserted into a patient's body at a certain angle, and acupuncture techniques such as twisting and lifting are used to stimulate specific parts of the human body to achieve the purpose of treating diseases. Puncture points are called human acupoints, or acupoints for short.
Regarding the history of needles, we have seen the beginning of the end in the Paleolithic Age. At that time, there were no special acupuncture tools, and some rough and slightly processed natural stones, scraping devices and sharp instruments were used to treat diseases. Until the new era, because of the progress of stone-making technology, a medical stone with a specific shape (a stone that can cure diseases) appeared.
Bian Shi is the earliest medical tool and the predecessor of metal needle knife. It was first used by people to break carbuncle or stimulate some parts of the body to relieve pain. Because the shape of bian stone must meet the needs of puncture or cutting, bian stone unearthed from archaeology has many shapes, mostly from Neolithic Age to the Spring and Autumn Period and the Warring States Period.
With the progress of productivity, in the Neolithic Age, people also learned to make needles like stone needles from animal bones and wild bamboo, which are smoother and finer than stone needles.
The appearance of metal needles in later generations was also made by imitating the shape of bian stone. For example, 1978, a bronze needle was found from a batch of ancient bronzes in Zhao Shulin commune, Dalat Banner, Inner Mongolia, and its shape and size were similar to that of a millstone needle unearthed from the Neolithic site in Tongtoudaowa, Duolun County, Inner Mongolia.
Various archaeological discoveries show that primitive people were often hit by sharp stones and thorns in their life and production practice because of the extremely bad environment and working conditions, and sometimes even scratched and bled. When they worked hard and struggled with wild animals, they were inevitably injured by stones and gravel.
But sometimes after the collision or bleeding, some of the original pain is relieved or disappeared (such as some persistent headaches, muscle aches and so on). ).
Obviously, this accidental experience is impossible to attract people's attention at first. However, when similar experiences are repeated for several years and times, this practical experience will prompt people to pay attention to certain parts of the body, and through artificial stimulation or bloodletting, they can receive the effect of treating diseases, so they gradually use it consciously and finally form acupuncture therapy.
The stainless steel medical needles used by people today are gradually developed and updated on the basis of ancient primitive needles such as stone, stone needle, bone needle and bamboo needle.
Moxibustion is to cauterize and fumigate some acupoints on the body surface with prefabricated moxibustion pots or herbs, and to prevent and treat diseases by thermal stimulation.
From the meaning of "moxibustion", it refers to treating diseases with long-term fire. Legend has it that people started cooking with fire in order to make people less sick. Use fire to keep out the cold and prevent animals from attacking and hurting. It has fundamentally changed people's primitive living habits, promoted health care and reduced diseases.
Before the pre-Qin period, moxibustion began to sprout, from burning muscles with firewood to moxibustion. During the Yin and Shang Dynasties, wood moxibustion, needle warming, moxibustion and fire therapy were widely spread. Moxibustion began to rise in the Tang and Song Dynasties, and some people began to sort out articles on moxibustion, and professional books on moxibustion came out one after another. Moxibustion reached its peak in the Ming and Qing dynasties, and it was sorted out and carried forward on the basis of predecessors. It is widely used in clinic and welcomed by the broad masses of the people. Then, due to social unrest, moxibustion was at a low ebb.
Self-regulation of acupuncture and moxibustion is that the guiding ideology takes the patient's "self-healing" as the leading aspect, and the treatment measures as the auxiliary means, mainly to remove diseases by improving the patient's disease-resistant function. The therapeutic measures of acupuncture and moxibustion are not the relationship between the arrow and the target, but directly act on the pathogenic focus, but act on the self-organization and self-maintenance function of the body as external fluctuations or synergistic forces, and take corresponding measures according to different situations, so as to consolidate the self-healing ability of the body, give play to its potential, increase and amplify its curative effect, and achieve the purpose of treating diseases.
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* * Placebo and Placebo Effect * * * *
In the14th century, the word placebo (Latin: I want to please) was first used in the prayers of mourners hired at funerals. During that time, the word "placebo" was worthy of being used by bereaved families at funerals instead of those who mourned and cried for the deceased.
These mourners often begin to mourn the dead with the poem "Placebo Domino in Vivorum Area" in Section 9 of Psalm 14 of the Bible. After being translated in the following Bible, this poem may mean "Where the living exist, I want to please God". Here, the word "placebo" means devaluation and substitution. This is because undertaker, a professional, is often employed to mourn instead of the families of the deceased.
The word placebo first appeared in1medical works in the late 8th century. In the New Medical Dictionary published by 1785, placebo is described as "a commonly used treatment method or drug". 181/The Quincy Medical Vocabulary revised in1sets the definition of placebo as an adjective, that is, the so-called efficacy of placebo is mostly to please patients rather than benefit them.
Until the first half of the 20th century, placebos seemed to have been widely used in the medical field. 1807, Thomas Jefferson recorded what he described as "pious fraud". About 100 years later, Richard cabot of Harvard Medical School described how he was trained to use placebos such as bread crumbs to treat patients.
In 1938, placebo was applied to the group name of the blank control. In the experiment, one group received the vaccine after treatment, and the other group received the same treatment as the experimental group, but the difference was that they took a placebo instead of a real vaccine. This placebo is actually just a lactose capsule, which is indistinguishable from the real vaccine in appearance.
The experimental results show that the probability of catching a cold in the course of the experiment is greatly reduced, which is almost equivalent to the therapeutic effect of people taking vaccines, which is the beginning of the increase of placebo effect.
Generally speaking, placebo is an intervention means to simulate medical treatment, not a specific treatment for the diseases it provides; Placebo effect is a therapeutic effect that leads to physical or psychological improvement due to personal or cultural expectations for treatment.
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Can't find meridian
Traditional Chinese medicine believes that meridians are the main branches and branches of human qi and blood circulation, which intersect vertically and horizontally and spread all over the body, connecting the inside and outside, viscera and limbs of the human body into a unified whole. Some people think that the meridians mentioned by the ancients are blood vessels in modern anatomy, and there is no independent meridian system.
In the 1950s, people found a strange phenomenon in acupuncture: some people would feel like marching along the meridians when receiving acupuncture treatment. Later, this phenomenon was officially named as the phenomenon of sensation along the meridian. People who can produce this phenomenon are called "meridian sensitive person", but such people only account for a small part of the crowd.
The discovery of sensation transmission along meridians reversed the viewpoint that meridians are blood vessels, because blood vessels obviously cannot form this phenomenon of sensation transmission along meridians. In addition, people also found that the skin resistance along the meridian is low, which laid a certain foundation for verifying the objective existence of the meridian.
With regard to meridians, researchers have invested a lot of time and energy, and even products related to meridians have appeared. However, the meridians have not been discovered.
In order to explore the existence of meridians, Zhu Qingshi, an academician of China Academy of Engineering, spent 10 years, and finally gained something. He was invited to give a speech, which finally triggered public discussion. (Ten years ago, Zhu Qingshi took the scientific explanation of meridians as his responsibility, and now he responds to the question like this. )
Professor Chen Ming of Beijing University of Chinese Medicine believes that meridians are a functional channel. On the one hand, the discovery of meridians may be just like cells, which need specific instruments and opportunities; On the other hand, meridians are likely to exist only in the living, and when people die, they will be gone. The meridians in traditional Chinese medicine are equivalent to the routes of airplanes. When the plane flies, it knows which line in the sky is the route, but it can't be seen when the plane lands.
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Impossible double blind
Evidence-based medicine, that is, medicine that follows evidence, is a new medical paradigm that has developed rapidly in the clinical field of the world in recent years. Its main ideas are: any medical decision should be based on objective clinical scientific research evidence; Any clinical diagnosis and treatment decision should also be based on the best research evidence and the relationship between clinical expertise and patient value.
In fact, there are a series of hierarchical structures of research methods in evidence-based medicine. The hierarchical structure of different research methods in evidence-based medicine is as follows:
Case study is the bottom of the structure, followed by retrospective and prospective comprehensive case studies, non-randomized controlled cohort studies, open randomized controlled trials and double-blind randomized placebo-controlled trials, while double-blind randomized placebo-controlled trials are the top of the hierarchy.
Therefore, the evidence results of double-blind randomized placebo-controlled trials are the basis of meta-analysis and systematic review. Although the hierarchical structure of this research method is based on the drug therapy model, it is now widely used to study other more complex non-drug therapies, such as traditional Chinese medicine and acupuncture.
However, because acupuncture is an interventional therapy, it cannot achieve its concealment and similarity like fake placebo, so it is difficult to completely design a placebo group with no therapeutic effect and no interference from essential factors.
It is impossible and unrealistic to set up blind methods for acupuncturists, subjects and researchers at the same time in clinical treatment trials. The specific treatment is carried out by the doctor himself, and the doctor must know whether he uses real acupuncture or fake acupuncture in the treatment. This is why it is difficult to design the trial as a double-blind randomized placebo-controlled trial, and its comfort needle can only deceive the subjects or other people, so it is difficult to meet the requirements of "double-blind" in double-blind randomized placebo-controlled trials.
Up to now, there is no unified, authoritative, standardized and recognized diagnostic criteria and efficacy evaluation criteria in the literature of acupuncture randomized controlled trials.
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Incompatible evidence-based medicine
In the experimental study of drugs, only by fully understanding the absorption and metabolism of experimental drugs, the recognition of molecular receptors, the activation of biochemical and physiological reactions and the inactivation of drugs, can we further design and develop placebos in the control group.
As far as acupuncture is concerned, the biggest challenge in designing a suitable sham acupuncture control group is precisely the lack of understanding of acupuncture mechanism by the researchers themselves, which leads to the researchers not knowing which one is likely to produce curative effect when designing the sham acupuncture control group, and inadvertently incorporating important elements that can really play a therapeutic role into the sham acupuncture control group.
In the study of drug therapy alone, the consistency and rationality of research methods in evidence-based medicine are beyond doubt. However, in the face of complex non-drug traditional medical treatment such as traditional Chinese medicine and acupuncture, this hierarchical structure should not be a structural model to guide research methods.
Placebo in western pharmacology completely separates physiological and psychological factors, while in acupuncture of traditional Chinese medicine, or in the system of traditional Chinese medicine, form, qi and spirit are a unified whole, and the research object is not just a single mechanical tangible substance in western scientific research. It attaches importance to the role of spiritual elements in diagnosis and treatment, and regards human emotions and desires as human nature.
In the diagnosis of traditional Chinese medicine, I don't know whether to observe the shape or not, but also to distinguish the spirit. Double-blind experiments to verify the efficacy of acupuncture or traditional Chinese medicine are entirely based on one standard to measure the content covered by another standard.
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* * Conclusions to be studied and discussed * * * * * * *
What is highly respected is that Netease wave has created a new style of writing: through the arrangement of public reports and materials, problems are reflected by logic and speculation, and interviews are almost completely unnecessary. This is undoubtedly a very successful case in the era when the portal website has no right to collect and write.
However, it is still a writer's basic accomplishment to look at problems objectively, scientifically and fairly.
Taking the true and false acupuncture experiment of acupuncture for treating low back pain as an example, there are 1 1 articles in foreign journals. Six articles concluded that there was no difference between acupuncture and sham acupuncture, and only 1 article directly concluded that acupuncture was only a placebo. Weak water is 3 thousand, can I give an example to prove it?
In ancient legends, wizards are practitioners who jump out of thinking and medicine. Undeniably, in the process of sacrifice, the theory of anatomy and understanding of nature was promoted because of the needs of reality. The predecessor of medicine is witchcraft, the earliest doctor is also a wizard, and the earliest treatment is witchcraft. Wizards were intellectuals at that time, just like scientists. They mastered the advanced technology and knowledge at that time. In ancient Greece, ancient India and ancient Babylon, we can see that literature records show that medicine originated from witchcraft, and medical skills are closely related to witchcraft.
? The role of "wizard" in the game
It is meaningful to analyze specific occupations in the specific background of the times. From the point of view of debate, it is untenable to split the original unified thing into two and take one side of the story as an argument to support the argument.
Medicine originated from witchcraft, but it is on an equal footing with witchcraft. Where should we start? Acupuncture has experienced ups and downs in China for thousands of years. It is the microscopic history of human beings' continuous cognition and improvement of the human body, from stone needles for treating diseases to bone needles and bamboo needles, to gold needles, silver needles and even modern sterile needles. It is ridiculous to demonstrate that acupuncture is not only useless, but also harmful with a set of excavated medical instruments and even logically unrelated data of China etiology.
Recently, the famous magazine Nature published a paper on the Internet that subverts most people's common sense: scientists from the University of California, San Francisco found that the lung has hematopoietic function, but its ability to produce blood cells is not low-in the mouse model, the number of platelets produced by the lung exceeds half of the total. This has never been found before.
Imagine: thousands of years ago, the ancestor's Huangdi Neijing knew that "the lung faces a hundred pulses", and Chinese medicine also relied on this theory to achieve miraculous effects in treating children's chronic obstructive pulmonary disease, pneumonia and other diseases.
Both Chinese medicine and western medicine are a way to explain the human body, or a way of thinking. To demonstrate a medicine, we must put it into our own theoretical system on the basis of in-depth understanding. From this perspective, the statement that acupuncture is a placebo is a paradox in itself.
Contemporary medical model faces two dilemmas. First, the second health revolution aimed at overcoming non-communicable chronic diseases such as cardiovascular and cerebrovascular diseases and cancer was blocked, which inspired people to reflect on the modern medical model-biological (therapeutic) medicine. On the other hand, the global medical crisis caused by the malignant expansion of medical expenses forces people to deeply reflect on the purpose and core media of medicine.
The results of a large sample epidemiological survey on the risk factors of heart disease in the United States show that biological factors (including heredity) account for 25%, lifestyle and behavior account for 54%, and environmental factors account for 9%.
For the occurrence of non-communicable chronic diseases, the role of people's lifestyle and behavior is far greater than biological factors. Effective control of these diseases requires the reform of medical model, that is, from biomedicine to a new medical model that integrates physiological, psychological, social and environmental factors. "
The development trend of contemporary science and medicine is to pay attention to the whole and part, synthesis and analysis, experience and experiment. In the transitional period from the era of experimental medicine to the era of holistic medicine, the object of medical treatment has changed into human health and disease. Chen Kaixian, an academician of China Academy of Sciences and former president of Shanghai University of Traditional Chinese Medicine, said that from this perspective, the integration of eastern and western medicine is an inevitable trend of contemporary medical development.
There is a sentence on the epitaph of Dr. Trudeau on Lake Saranak in northeastern new york:
Heal sometimes, relieve often, comfort always. Sometimes it is a cure; Often help; Always comforting.
Sometimes healing is always comforting. This is medicine.
Reference article:
[1] Lin, reasons and analysis of acupuncture as a placebo.
[2] Shao Hong's historical research on moxibustion.
[3] Ma Shilin's "On the History and Present Situation of Moxibustion"
[4] Chen Kaixian, "The development of contemporary medicine needs Chinese medicine, and eastern and western medicine will inevitably converge".
[5] Chen "On the Origin of Acupuncture"
[6] The history and development of experimental design of placebo effect research in Zhang Wencai.
[7] Liu Jing et al., "Research progress and related problems of comfortable acupuncture control design".
[8] The comfort control method of acupuncture clinical trial designed by Zhou Jianying.
[9] Zhang Hongfeng's "Management Status of Acupuncture Needle Disinfection and Sterilization"
[10] He Wei's comparison of western acupuncture and China acupuncture and its enlightenment.
[1 1] Zhang Jianliang's research on meridian theory and acupuncture principle.
[12] The development history and research status of modern acupuncture disease spectrum in Xiong Jun.