Gerhard Litscher, Zang-Hee Cho (Eds.)
Pabst Science Publishers
Preface from Richard R. Ernst (Nobel Prize Laureate 1991)
The scientific and technological progress of the past century has truely revolutionized clinical medicine. The 20th century was certainly so far the most successful and innovative period in medical history. Life expectancy has significantly increased and many diseases are today under reasonable control, although sometimes with enormous instrumental and personnel efforts which often can hardly be financed.
During the same period, surprising holistic therapeutic procedures, having their origin in ancient Asian cultures, became known in the west. They have been practiced for many centuries, apparently with great success and almost without technical means. At first, these mysterious practices have been turned to ridicule by the traditional western school medicine, as being connected to superstition and charlatanism. Indeed, the explanations given by the eastern practitioners could hardly be accepted by western scientifically trained critical mind.
Nevertheless, these magic procedures have become fashionable and, sometimes, even effective also in the hands of western medical practitioners. Today these alternative medical treatments are generally accepted as being of some undeniable benefit. However, from a scientific standpoint, the working principles behind them remain obscure even today. Slowly, some serious and brave researchers started tedious investigations to uncover the logic principles, if any, behind these fascinating procedures.
The contributions in the present volume attempt to shine some scientific light upon perhaps the most spectacular of these eastern medical procedures: acupuncture. The usage of advanced exploratory tools, such as ultrasound and magnetic resonance imaging, provides revealing insights. Even the most critical western scientist might become convinced that the observed effects are reproducible and are accessible to a scientific understanding.
The volume fills a true gap and presents an up-to-date account of our scientific understanding of acupuncture. Perhaps it is necessary to remind the reader of an old and very general truth of science: Scientific investigations never reveal the true principles behind the observed effects. They lead in the best case to models that can explain all known observations and are not in contradiction with any of them. But it would be unscientific to claim that nature and models are identical. The two are just compatible within the framework of our present knowledge. Tomorrow already, the situation may be different. The results presented in this volume have to be interpreted in this sense. We might have gained an operational model of acupuncture without having lifted all the underlying secrets.
Medicine, in general, is more than just a subdiscipline of rational science. It is also an art and an active form of human interaction, requiring much intuition, experience, and compassion from the side of the medical personnel as well as a great deal of good will from the side of the patient. I hope that the present volume ‘Computer-Controlled Acupuncture’ does not lead to the false conclusion that medicine could be fully computer-controlled. I am convinced that that particulary in medicine, but also in many other fields of activity, human interrelations and mutual understanding in a more intuitive manner remain the true guidelines in our hopefully beneficial ventures.
Zurich, November 1999
Richard R. Ernst
Nobel Prize Laureate 1991
Book Review 1 David F Mayor MA MBAcC
|Professor Cho (Irvine, California) will now be familiar to
many readers as a pioneer in the field of fMRI who has turned his
attention to the effects of acupuncture at points with different
traditional functions. In their chapter here, his group again investigates
how manual acupuncture can selectively affect regional cerebral bloodflow
(in the visual cortex with GB37, and in the auditory cortex with GB43 or
Professor Litscher (Graz) has, with a number of coworkers, been using infrared spectroscopy and a newly evolved transcranial Doppler sonography (TCD) system to determine changes in bloodflow in the brain in response to acupuncture, in combination with new and highly sensitive EEG methods. This ability to detect both together is potentially very powerful. Seven of the chapters in the book concern this exciting work. In addition, a study on peripheral infrared thermography demonstrates how variable temperature responses can be to identical manual needling in different subjects (unfortunately there was no mention of whether this variation depended on initial temperature and circulatory dynamics). In a further chapter, Litscher's group shows how laser doppler flowmetry may help to separate responders and nonresponders to acupuncture, using a nonspecific 'formula' for enhancing qi and so improving peripheral microcirculation (bilateral P6, St36, Sp6, and Ren6 with moxa in addition).
They also show that the same points enhance cranial bloodflow, and then go on to demonstrate more specific effects: needling these points increases mean blood flow velocity (Vm) in the middle cerebral artery while leaving unchanged that in the supratrochlear artery (a branch of the ophthalmic artery). On the other hand, needling points specifically selected for their effect on the eye has the opposite effect (this group included both local and distal points). These differences are all the more interesting as both arteries derive from the internal carotid. In a further study, gently needling LI20 enhanced Vm in the anterior cerebral artery, but needling of Bl67 in the posterior cerebral artery, in keeping with the traditional functions of these two points for olfaction and vision, respectively.
Litscher's group also demonstrate how needling has more of an effect on both cerebral circulation and acoustically-induced 40 Hz cortical responses than laser acupoint stimulation (with commonly accepted parameters for both methods). Whether comparison of 20 minutes of needle retention with 30 seconds of irradiation is really meaningful is another question (in another study published elsewhere,1 similar results were obtained with 20 seconds stimulation for both modalities; in addition, there was less effect at a nonacupoint than at the acupoints used).
The remaining chapters are by Nissel on chaos theory, quantum physics and acupuncture, Streitberger's group on their placebo method (well known to those who attended the October 2000 BMAS Scientific Meeting), Klima and others on 'laserpuncture,' together with contributions from Raftis on a new chin and cheek acupoint microsystem used in conjunction with Yamamoto's scalp acupuncture, a factual little article on Ötzi the iceman by the group responsible for interpreting his tattoos in acupuncture terms, and an incomprehensible offering from Wang Weikung's Taipei group on the 'blood pressure pulse spectrum' (having read at least ten of their articles now, I feel little the wiser - maybe I am just stupid).
All in all, this is an important little book for those who are looking
for scientific evidence of the effects of acupuncture and of different
acupoints. Although many of the studies included are really pilots, with
only small groups of subjects, together they are persuasive and
fascinating. And although no conclusions are possible from this work on
the existence or nonexistence of meridians, the central role of the brain
in acupuncture is emphasised once again. Using the tools of
'Computer-Controlled Acupuncture ®' could provide a lot more answers to
the age-old question of how acupuncture works.
David F Mayor MA MBAcC in: The Journal of Chinese Medicine, 2001.
David F Mayor MA MBAcC in: Focus on Alternative and Complementary Therapies, March 2001 6(1)
Book Review 2 Adrian White MA BM BCh
This volume consists of a series of assorted papers, whose authors are mainly Austrian or German, which could be regarded as representing the leading edge of research into physiological measurements of the response of acupuncture needling. The contributions cover thermography skin temperature, regional cerebral oxygenation, transcranial Doppler ultrasonography, functional MRI, and laser Doppler flowmetry. The exception to the German-speaking sources is the work of Cho and colleagues in the USA and Korea, who describe their ground-breaking work with functional MRI. Then the editors add some theoretical physics about chaos theory and some theory and practice of laser therapy, contributions from Streitberger on his new placebo needle and Dorfer on the tattoo markings of the Iceman Oetzi. The reader is soon convinced that the German-speaking world is currently making a serious contribution to thinking about acupuncture.
This book is focused around the work of Litscher and colleagues in Graz, Austria, in which they used transcranial Doppler sonography to measure blood flow in various intracranial arteries. After finding that the middle cerebral artery flow was increased by one set of points, they demonstrated that a different sets of points influenced the posterior cerebral artery, whereas local points around the eye could differentially affect the supratrochlear artery. The team may have made an important discovery, but as a natural skeptic who has seen many claims for clever technology related to acupuncture come to nothing in the long run, I have slight reservations about research like this that seems too good to be true.
The authors have a neat hypothesis, which the results of the controlled laboratory research support perfectly every time. There seems no flaw in the methodology and the reports are clear and detailed. The studies are replicable and this should be done in other centers. With many of these methods of measurements, the specialists are pushing the technology to its limits and the non-specialist is poorly equipped to make a personal assessment.
There are some minor technical problems with the book, such as lack of page numbers in the list of contents. Some of the figures in the papers, such as thermograms, are in black and white but have legends that refer to the colours. However, the colour pictures do appear in a special section a the end of the book, which I could have discovered if I had read the contents list right trough. The reader is left rather tantalised by the intriguing title of "Computer-Controlled Acupuncture®" which, although appearing as the title of the book and in four chapter headings, is never properly defined or adequately explained. Using their imagination, the reader is left thinking that this refers to the use of high-technology equipment to investigate acupuncture in the laboratory. But how does that warrant a registration mark?
If you want a good summary of modern acupuncture physiological measurements, especially the methods of Litscher and colleagues, you will enjoy this book and it will certainly give you plenty to think about.
Adrian White MA BM BCh in: Focus on Alternative and Complementary Therapies, March 2001 6(1)