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The Practice Of Chinese Medicine: The Treatment Of Diseases With Acupuncture And Chinese Herbs, 2e B

Traditional Chinese medicine (TCM) is an alternative medical practice drawn from traditional medicine in China. It has been described as "fraught with pseudoscience", with the majority of its treatments having no logical mechanism of action.[1][2]

The Practice of Chinese Medicine: The Treatment of Diseases with Acupuncture and Chinese Herbs, 2e b

A 2007 editorial the journal Nature wrote that TCM "remains poorly researched and supported, and most of its treatments have no logical mechanism of action."[2][43] Critics say that TCM theory and practice have no basis in modern science, and TCM practitioners do not agree on what diagnosis and treatments should be used for any given person.[8] A Nature editorial described TCM as "fraught with pseudoscience".[2] A review of the literature in 2008 found that scientists are "still unable to find a shred of evidence" according to standards of science-based medicine for traditional Chinese concepts such as qi, meridians, and acupuncture points,[44] and that the traditional principles of acupuncture are deeply flawed.[45] "Acupuncture points and meridians are not a reality", the review continued, but "merely the product of an ancient Chinese philosophy".[46] In June 2019, the World Health Organization included traditional Chinese medicine in a global diagnostic compendium, but a spokesman said this was "not an endorsement of the scientific validity of any Traditional Medicine practice or the efficacy of any Traditional Medicine intervention."[47][48][49]

Concepts of the body and of disease used in TCM are pseudoscientific, similar to Mediterranean humoral theory.[9] TCM's model of the body is characterized as full of pseudoscience.[71] Some practitioners no longer consider yin and yang and the idea of an energy flow to apply.[72] Scientific investigation has not found any histological or physiological evidence for traditional Chinese concepts such as qi, meridians, and acupuncture points.[a] It is a generally held belief within the acupuncture community that acupuncture points and meridians structures are special conduits for electrical signals but no research has established any consistent anatomical structure or function for either acupuncture points or meridians.[a][73] The scientific evidence for the anatomical existence of either meridians or acupuncture points is not compelling.[74] Stephen Barrett of Quackwatch writes that, "TCM theory and practice are not based upon the body of knowledge related to health, disease, and health care that has been widely accepted by the scientific community. TCM practitioners disagree among themselves about how to diagnose patients and which treatments should go with which diagnoses. Even if they could agree, the TCM theories are so nebulous that no amount of scientific study will enable TCM to offer rational care."[8]

If the baby and mother survived the term of the pregnancy, childbirth was then the next step. The tools provided for birth were: towels to catch the blood, a container for the placenta, a pregnancy sash to support the belly, and an infant swaddling wrap.[106] With these tools, the baby was born, cleaned, and swaddled; however, the mother was then immediately the focus of the doctor to replenish her qi.[96] In his writings, Cheng places a large amount of emphasis on the Four Diagnostic methods to deal with postpartum issues and instructs all physicians to "not neglect any [of the four methods]".[96] The process of birthing was thought to deplete a woman's blood level and qi so the most common treatments for postpartum were food (commonly garlic and ginseng), medicine, and rest.[107] This process was followed up by a month check-in with the physician, a practice known as zuo yuezi.[108]

Since therapy will not be chosen according to the disease entity but according to the pattern, two people with the same disease entity but different patterns will receive different therapy.[109] Vice versa, people with similar patterns might receive similar therapy even if their disease entities are different. This is called yì bìng tóng zhì, tóng bìng yì zhì (异病同治同病异治; 'different diseases, same treatment; same disease, different treatments').[109]

A 2011 overview of Cochrane reviews found evidence that suggests acupuncture is effective for some but not all kinds of pain.[219] A 2010 systematic review found that there is evidence "that acupuncture provides a short-term clinically relevant effect when compared with a waiting list control or when acupuncture is added to another intervention" in the treatment of chronic low back pain.[220] Two review articles discussing the effectiveness of acupuncture, from 2008 and 2009, have concluded that there is not enough evidence to conclude that it is effective beyond the placebo effect.[221][222]

Although there are no regulatory standards for the practice of TCM in New Zealand, in the year 1990, acupuncture was included in the Governmental Accident Compensation Corporation (ACC) Act. This inclusion granted qualified and professionally registered acupuncturists to provide subsidised care and treatment to citizens, residents, and temporary visitors for work or sports related injuries that occurred within and upon the land of New Zealand. The two bodies for the regulation of acupuncture and attainment of ACC treatment provider status in New Zealand are Acupuncture NZ[252] and The New Zealand Acupuncture Standards Authority.[253][254]

As previously mentioned, antihypertensive therapy research on Chinese herbal formulas for treating hypertension has made rapid progress over the past 30 years, but certain problems remain that seriously limit the progress of this research; these problems should be solved as soon as possible. Currently, the clinical hypertensive treatment trials using TCM have been limited to small samples of curative effects, and multicenter, large-scale random samples with controlled methods are rarely employed. This limitation leaves the clinical practice of Chinese herbal formulas for treating hypertension short of definitive clinical evidence. Thus, the evaluation criteria of the clinical outcomes of hypertension must also attend to BPV rather than the value of casual BP (clinical BP) as a medical efficacy appraisal standard. Moreover, many experiments have primarily focused on the mechanisms of one aspect of specific Chinese herbal formulas for treating hypertension. The experimental methodology requires rigor, and only a few studies have included in vitro and in vivo samples in the same design.

Chinese medicine does not have a single explanation of the autoimmune pathology as obviously ancient Chinese medicine could not have such a view of the immune system. One can of course use a Chinese identification of patterns for each of these diseases and treat them successfully, but that does not really explain the autoimmune pathology or whether there is a common thread in the treatment of these diseases. For example, we can treat Hashimoto Thyroiditis successfully without any reference to it being an autoimmune disease. However, is there a single, underlying pathology in all autoimmune diseases and a common thread in the their treatment?

As one can see, this list is so extensive that practically every formula we use will have some anti-inflammatory herb in it. I believe it is very important to use some anti-inflammatory herbs in the treatment of autoimmune diseases. I especially use Mu Dan Pi Cortex Moutan. It is worth also noting that the anti-inflammatory herbs are found in many different categories of herbs, not just those that clear Heat: thus having an anti-inflammatory effect does not necessarily involve clearing Heat from the Chinese perspective. Indeed, it is very interesting (and somewhat surprising) that even Fu Zi and Cao Wu (extremely hot herbs) are anti-inflammatory.

While there have been many studies of its potential usefulness, the vast majority of papers studying acupuncture in the biomedical literature consist of case reports, case series, or intervention studies. One of the difficulties with drawing conclusions from the existing literature is that the term acupuncture is used to describe a variety of treatments that differ in many important aspects according to level of effect (e.g., local, segmental, generalized) and type of acupuncture treatment (e.g., manual versus electrical acupuncture). Many of these studies provide equivocal results because of design, sample size, and other factors. The issue is further complicated by inherent difficulties in the use of appropriate controls, such as placebos and sham acupuncture groups, and by absence of studies comparing acupuncture with conventional biomedical treatments. Some factors needing investigation include frequency, number, and duration of treatments, depth of puncture, number of acupuncture points used, combination with other therapies, sample size, setting, blinding factors, and needle size. Be that as it may, promising results have emerged on the efficacy of acupuncture in adult post-operative and chemotherapy nausea and vomiting and in postoperative dental pain.

There is evidence to support the use of acupuncture in migraine. In a large randomized controlled study (n = 401), Vickers et al (2004) examined the effects of a policy of "use acupuncture" on headache (predominantly migraine), health status, days off sick, and use of resources in patients with chronic headache compared with a policy of "avoid acupuncture". Patients were randomly allocated to receive up to 12 acupuncture treatments over 3 months or to a control intervention offering usual care. Headache score, SF-36 health status, and use of medication were assessed at baseline, 3, and 12 months. Use of resources was assessed every 3 months. Headache score at 12 months, the primary end point, was lower in the acupuncture group (16.2, SD 13.7, n = 161, 34 % reduction from baseline) than in controls (22.3, SD 17.0, n = 140, 16 % reduction from baseline). The adjusted difference between means is 4.6 (95 % confidence interval [CI]: 2.2 to 7.0; p = 0.0002). This result is robust to sensitivity analysis incorporating imputation for missing data. Patients in the acupuncture group experienced the equivalent of 22 fewer days of headache per year (8 to 38). SF-36 data favored acupuncture, although differences reached significance only for physical role functioning, energy, and change in health. Compared with controls, patients randomized to acupuncture used 15 % less medication (p = 0.02), made 25 % fewer visits to general practitioners (p = 0.10), and took 15 % fewer days off sick (p = 0.2). The authors concluded that acupuncture leads to persisting, clinically relevant benefits for primary care patients with chronic headache, particularly migraine.


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