Acupuncture: Review And Analysis Of Reports On Controlled Clinical Trials
Geneva: World Health Organization
2002 (ISBN 9241545437)
Reviewed by Steven K. H. Aung, MD
This WHO report is a vitally important addition to the theoreti-
cal, clinical, and spiritual "shopping cart" of diligent practitioners,
teachers, and students of medical acupuncture as well as their patients around the world. It is currently available for a free Internet download in the English language1 (http://www.who.int/medicines/library/trm/
The hard copy can be purchased via WHO.org or Amazon.com websites. As stated in the introduction (written by Dr Xiaorui Zhang, Acting Coordinator, Traditional Medicine, WHO Department of Essential Drugs and Medicine Policy), the focus is on data reported in recent years from controlled clinical trials. This is a perspective emanating from the 1996 WHO consultation in Milan/Cervia, Italy. (I was one of the invited international consultants and participants.)
The report is divided into 4 main sections, summarized as follows:
Definition. Acupuncture is a method of puncturing with needles at selected/specific sites on the body, often in conjunction with moxibustion (application of herbal heat), as well as the application of pressure, electricity, and other stimulation techniques.
Need for Evaluation. While acupuncture has continued to survive throughout the centuries, there is a need for scientific evaluation of its effects. In modern biomedicine, this is viewed in terms of controlled clinical trials.
Evaluation Methodology. There are difficulties in ruling out the placebo effect. However, if rapid improvement is evident in a patient despite the absence of relevant controlled clinical trials, especially in chronic conditions, then the effects of acupuncture may be assessed more positively. The effects of acupuncture seem to depend on the proficiency of each individual practitioner.
Safety. Acupuncture is a safe, non-addictive, therapeutic modality when performed by qualified practitioners, especially in regard to pain control – even if the effects are not as immediately apparent as the application of pharmaceuticals such as corticosteroids.
Availability and Practicality. Acupuncture is a simple, inexpensive treatment in developing countries where medical services are often inadequate, and it is also valuable in highly developed countries where it may be viewed as a viable complementary approach.
Studies on Therapeutic Mechanisms. Scientific research suggests that acupuncture induces analgesia, enhances immunity, and helps to regulate physiological functions. It is a mildly invasive, non-iatrogenic approach that should not be utilized as a substitute for proper biomedical treatment.
Selection of Clinical Trial Reports. Controlled clinical trials encompass the optimal scientific evidence for the efficacy of acupuncture. However, non-randomized trials in the form of group comparisons are also valuable.
Review of Clinical Trial Reports
In this section of the report, a number of clinical areas are discussed: namely, pain, head and face, locomotor system, gout, biliary and renal colic, traumatic or postoperative pain, dentistry, childbirth, surgery, infections, neurological disorders, respiratory disorders, digestive disorders, blood disorders, urogenital disorders, gynecological and obstetric disorders, cardiovascular disorders, psychiatric disorders and mental disturbances, pediatric disorders, disorders of the sense organs, cancers, and other reports. The relevant research literature is referenced in each of these areas.
Diseases and Disorders That Can
Be Treated with Acupuncture
This section encompasses 28 conditions for which acupuncture has proven to be scientifically effective (Figure 1).
Another 63 conditions are listed for which the therapeutic effects of acupuncture have been shown but not proven to be of therapeutic benefit. These include cancer pain, earache, fibromyalgia, insomnia, obesity, schizophrenia, and urolithiasis. Similarly, a small number of conditions are listed pertaining to the possible value of acupuncture in other difficult conditions or those requiring special expertise, such as deafness, chronic pulmonary/heart disease, coma, and paralysis.
Summary Table of Controlled Clinical Trials
The relevant data are presented in an extensive "summary table" format encompassing about 50% of the entire report.
OF THE REPORT
The 1st section of the report is well done. A more clinically precise definition of acupuncture and ancillary therapies (such as cupping) should have been presented. The 2nd and 3rd sections of the report are well done and appropriately
connected to the 4th section, the comprehensive tabular data.
However, there is a tendency to exalt so-called hard scientific-
type data over and above the various viable soft models of clinical practice, initiated and developed over the years and centuries by traditional Chinese and other healing masters working together with their patients.
My opinion as well is that a listing of those dedicated researchers and clinicians who have devoted their time and energy toward the installation of this project should have been included in recognition of their efforts in helping support the WHO initiatives in this important area through the years.
In conclusion, for all seriously concerned medical acupuncturists, this WHO report is a valuable overview and synergistic account of many of the relevant scientific studies. Overall, this work continues the modern tradition of the WHO Traditional Medicine Program initiatives oriented around the "standardization" of Chinese traditional medicine – East and West, North and South.2-4
Thus, it is a useful research and clinical reference work for qualified health care practitioners seriously interested in the ongoing potentiality, impact, and efficacy of Chinese traditional medicine for the
benefit of their patients; specifically, medical acupuncture. There are 293 references, most of which pertain to works in English; over one-third entail Chinese sources, and several other languages and cultures are represented, notably, German, Japanese, Russian, and Indonesian.
Reading and inculcating the scope and wisdom of this work is medically indicated in conjunction with other relatively recent and valuable comprehensive overviews5 for readers, clinicians, and researchers.
2. World Health Organization. Acupuncture. World Health: The Magazine of the World Health Organization. 1979 (special issue).
3. World Health Organization. A Proposed Standard International Acupuncture Nomenclature: Report of a WHO Scientific Group. Geneva: WHO; 1989.
4. World Health Organization. Guidelines on Basic Training and Safety in Acupuncture. Geneva: WHO; 1999.
5. Jobst KA, Eskinazi DP, eds. NIH technology assessment workshop on alternative medicine: acupuncture. J Altern Complement Med. 1996; 2 (special issue).
The Unbroken Field – The Power
Of Intention In Healing
By Michael Greenwood, MD
Paradox Publishers, Victoria, BC, Canada; 2004
400 pages; US $14.95, Canada $18.95
Reviewed by James Rotchford, MD
Michael Greenwood, MD, is familiar to many of us in the academy. He has led workshops for members and has published several articles within this journal. He previously published 2 books related to his work as physician and healer. Indeed, his first book written in conjunction with Peter Nunn, Paradox and Healing, prompted me to call him. I then had the opportunity to participate in and witness his work at the Victoria Pain Clinic. His second book, Braving The Void, further elaborates upon his experiences at the Victoria Pain Clinic and provides some theoretical grounds for his observations at the Clinic. Dr Greenwood is a healer and clearly a pioneer in the domain of chronic pain management.
The Unbroken Field is more than a synthesis of his early work. It establishes Dr Greenwood as a seasoned proponent of not only "energetic" medicine but also one able to integrate energetic/hands-on approaches into current psychological and spiritual models. His general theme is simple yet radical for a modern Western physician: symptoms are to be honored and explored as a means of individual development and/or self-actualization. Although Dr Greenwood never uses these ambiguous terms, they convey a major theme of the book. The relief of presenting symptoms is the result of, not the objective, of his approach to healing. Practical implications of the above theme abound in the book.
The first 9 chapters of the book consider pertinent evidence and traditions associated with looking at humans as "energy." He provides an excellent review, both for the lay and professional reader. In addition to traditional Oriental medicine models, he also includes Western concepts and Hindu teachings on the chakras.
In chapter 10, he again emphasizes the need to explore and integrate symptoms, in part, to provide an antidote to the alienation and existential anxiety stemming from our "Western" perspective in which symptoms are simply problems to be fixed. Practitioners who are familiar with Five Element acupuncture and French Energetics will especially feel comfortable with his clinical cases. He explores in detail what he calls "Dynamic Interactive Acu-Bodywork." In his model, the practitioner as well as the patient must be willing to let go of preconceived notions of how things should be, and explore what is and will be. One of his major means of "diagnosis" is to palpate and explore for "active" points on the body.
He also outlines a practical meditative practice (Dynamic Meditation) that he maintains is helpful in allowing the exploration of symptoms to continue. Although a strong proponent of daily meditation, he is not naive to some of the traps and pitfalls associated with using meditation as just another "dissociative" approach. To use his terminology: "Transcendence and transformation must work together like a kind of warp and woof."
The book is intellectually challenging for it confronts what are standard assumptions and thought processes of orthodox medicine. Nevertheless, I think the book is readable even for the general population. It provides a number of case histories and examples that are uncluttered by medical terminology. I have started to recommend this book to established patients as a way of further awakening them to the distinct reality that there are ways other than surgery and medications to approach pain problems. There are also specific instructions about how to proceed with meditation and other self-caring practices.
The most seasoned clinician in acupuncture will also find the material engaging. Dr Greenwood's clinical insights using Five Element and Energetic models were enough to make the book commendable. Often while reading the book, I felt as though I was listening to a stirring sermon. I recognized the truth and even practical implications of what was being shared, and felt a sort of eagerness about integrating what I learned into my life, but yet, after laying the book down, I felt a little confused by how the message could be fully integrated into the world in which I commonly work. This feeling is a little reminiscent of my initial exposures to acupuncture. Hmm!