Research on Chinese medicine
looking for research activities on Chinese medicine in and around Switzerland

Recently I received an e-mail advertising a new journal, Elsevier Medical Case Reports. On their website you find:

“Elsevier Medical Case Reports is an open-access, peer-reviewed online journal publishing case reports from all disciplines of clinical medicine and professional healthcare (except alternative and complementary medicine/healthcare).”

Two questions popped up immediately:

1) Why not from alternative and complementary medicine?

2) Why are they sending this to me, a practitioner of Chinese medicine, when they obviously don’t want to publish my case reports?

Feel free to submit your ideas…

Japan isn’t really close to Switzerland, but I love this article and want to share it:

Kurono Y, Minagawa M, Ishigami T, Yamada A, Kakamu T, Hayano J (2011). Acupuncture to Danzhong but not Zhongting increases the cardiac vagal component of heart rate variability. Auton Neurosci., doi:10.1016/j.autoneu.2010.12.003

The authors perform superficial acupuncture with the needle being pulled out immediately. They are able to show that acupuncture at Ren17 but not Ren16 increases the R-R interval and its variation in healthy volunteers.

Conclusions of this work are:

• De-Qi sensation is not necessary for acupuncture to show effects. Therefore, using shallow acupuncture as “sham” or control acupuncture doesn’t really make sense.
• There are point-specific effects: “…stimulating specific locations causes the modulation of specific physiologic functions.”

Thank you for this work!

On 3-4 December 2010, the 3rd European Congress for Integrative Medicine took place in Berlin. Due to the lovely weather (about -10°C with lots of snow), some researchers didn’t even make it to Berlin.

After the opening of the congress, various speakers reported about the perspectives in their countries. Since I am interested in slide layouts, I started to take pictures. E.g. in this one, do you think the Chinese and the English text are saying the same (“In China, researches found the patients of Kidney Yang deficient shown lower hydroxyl-17 in urine. The result has high repeatability.”)?

On Friday evening, there was a great session on “Patient and Physician Relationship and Placebo”. Irving Kirsch talked about arguments against placebos – that are at the same time also arguments against the treatments, and proudly presented his newest work showing that placebos have effects even when the patients are told they are receiving a placebo. Now, of course, we all wonder what implications these findings have on the conclusions drawn from placebo-controlled studies.

Harald Walach proposed to consider patients more as “active agents” than as “passive recipients”.

On Saturday morning, there was a session on “Allergy and Integrative Medicine”. Benno Brinkhaus reported some results from the ACUSAR study. Although the slide says that “Acupuncture was not non-inferior to 1) Sham Acupuncture and 2) Rescue Med” and despite a rather unreasonable protocol, he could actually show positive effects of acupuncture.

Finally, George Lewith presented his concept of food allergy and pointed out that there is not one single method that has all the answers to this problem. I especially liked the slide below: why bother to draw a human shape, when you can represent your patient as a barrel?

Abstracts can be found in the December issue of the European Journal of Integrative Medicine.

Thanks to Christian for pointing out this blog:

Science, Reason and Critical Thinking

where Crispian Jago helps us to find a suitable alternative therapy. If you are looking for a traditional alternative therapy, where the preferred energy balancing method is stabbing, try acupuncture.

In March 2010, Woo et al. wrote an editorial in BMJ entitled: “Acupuncture transmitted infections are underdiagnosed, so clinicians should have a high index of suspicion”. They suggest “To prevent infections transmitted by acupuncture, infection control measures should be implemented, such as use of disposable needles, skin disinfection procedures, and aseptic techniques.” Guess what: we already use single use needles. But my own observation tells me, that there are in fact potentially dangerous bugs on the skin just waiting to get into the body through a hole remaining after the needle has been taken out. Have a look at this picture taken by WS (and fondly decorated by myself):

For serious large observational studies on the safety of acupuncture, see:

White A, Hayhoe S, Hart A, et al. Adverse events following acupuncture: prospective survey of 32 000 consultations with doctors and physiotherapists. BMJ 2001;323(7311):485-486.

MacPherson H, Thomas K, Walters S, et al. The York acupuncture safety study: prospective survey of 34 000 treatments by traditional acupuncturists. BMJ 2001;323(7311):486-487.

Witt CM, Pach D, Brinkhaus B, et al. Safety of acupuncture: results of a prospective observational study with 229,230 patients and introduction of a medical information and consent form. Forsch Komplementmed 2009;16(2):91-7.

La Marca R, Nedeljkovic M, Yuan L, Maercker A, Ehlert U.
Effects of auricular electrical stimulation on vagal activity in healthy men: evidence from a three-armed randomized trial.
Clin Sci. 2010;118:537-546.

“After controlling for respiration, condition-specific pain sensation, individual differences in belief of acupuncture effectiveness and time effects not attributable to the interventions, electroacupuncture but not manual acupuncture was found to have a positive effect on RSA_TR (respiratory sinus arrhythmia adjusted for tidal volume).”

What are the 10 most commonly used Chinese herbs in Switzerland? - Dang Gui, Fu Ling, Bai Shao, Gan Cao, Bai Zhu, Chai Hu, Chuan Xiong, Zhi Gan Cao, Huang Qi and Shu Di Huang.

Read more in: Klein SD, van der Zypen D, Becker S. Prescription Patterns of Chinese Medicinal Herbs in Switzerland. Schweiz Z Ganzheitsmed. 2010;22:226-231 (DOI: 10.1159/000317533)

11th – 12th September 2010
The British Conference of Acupuncture and Oriental Medicine
Royal Holloway University of London, Egham, Surrey

26th – 28th November 2010
4th International TCM Congress
Mannheim

3rd – 4th December 2010
3rd European Congress for Integrative Medicine
andel’s Hotel Berlin

9th – 10th December 2010
4th ASA TCM Congress
Congress Center Basel

7th – 9th May 2011
6th International Congress on Complementary Medicine Research
Chengdu, China

13th – 15th May 2011
ICMART
The Hague, Netherlands

How Thomas Bratzke treats a building with acupuncture:

Brinkhaus B et al.: Acupuncture in seasonal allergic rhinitis (ACUSAR) – design and protocol of a randomised controlled multi-centre trial. Forsch Komplementmed 2010;17:95-102.

Before you expect any results from the trial in this publication, I have to disappoint you. This is only the study protocol. (Why would one publish a study protocol?) The authors refer to two reviews that find “insufficient evidence to support or refuse the use of acupuncture in patients with allergic rhinitis” and state “that a large well-conducted RCT, which overcomes identified methodological problems would be required”. And although they present a sophisticated study protocol considering outcome measures, statistical analysis, recruitment of patients etc., I wonder whether there will be any useful results from this study.

Let’s look back and remember GERAC and ART (former studies undertaken by the very same authors), the problems of which have been well described by Stephen Birch. Have the authors of the now presented study protocol learned from their previous mistakes? Unfortunately, they haven’t.

• “As in the ART trials, we have used explicit and rigid criteria to ensure that the physicians in the study have a high level of education and practical experience.” And they consider 350h of training in acupuncture a high level.
• “Non-medical acupuncturists were not included in the study.” Why? Afraid, that the non-medical acupuncturists could do better then the physicians?
• “The treatment strategies for acupuncture and penetrating sham acupuncture were developed in a consensus process with experienced acupuncture experts from two major German societies…” Regrettably, the reasoning behind the choice of points is not presented and it is not clear what literature (Chinese or Western) was considered.
• “We are aware that penetrating sham acupuncture is not a valid placebo intervention. But as all other sham control concepts fail to represent a valid placebo as well, we use – as in the ART trials – penetrating sham acupuncture as ‘sham control group’.” But then please stop calling it “sham acupuncture”. And if you don’t find different outcomes between the “acupuncture” and the “sham acupuncture” group, don’t conclude again that it doens’t matter where you stick the needles, ok?

The last two sentences of the Discussion are: “In conclusion, the ACUSAR study is one of the largest and most rigorous studies of acupuncture including a sham control group conducted in SAR thus far. This study will have an impact on the decision of whether acupuncture should be considered as a therapeutic option in the treatment of SAR.” I hope it won’t.