Over on my HinesSight blog yesterday, I posted "Some life lessons from a Tai Chi seminar."
These were some of the insights I got from a special three-hour class my Tai Chi instructor, Warren, put on for five students who are especially interested in the martial side of Tai Chi, as contrasted with the energetic/exercise side.
During the seminar Warren, who used to teach classes in East-West Medicine at a nearby college, talked about the meridians that are part of Chinese medicine. This is how a Wikipedia article about meridians starts off.
The meridian system (simplified Chinese: 经络; traditional Chinese: 經絡; pinyin: jīngluò, also called channel network) is a pseudoscientific concept from traditional Chinese medicine (TCM) that alleges meridians are paths through which the life-energy known as "qi" (ch'i) flows.
Meridians are not real anatomical structures: scientists have found no evidence that supports their existence. One historian of medicine in China says that the term is "completely unsuitable and misguided, but nonetheless it has become a standard translation." Major proponents of their existence have not come to any consensus as to how they might work or be tested in a scientific context.
I'd heard Warren describe meridians several times before. He knows their names and where they supposedly are in the human body. But I don't recall him ever talking about how someone can prove that they exist, or why they're relevant to Tai Chi practice.
From what I can tell, Tai Chi supposedly facilitates the movement of qi/chi in the body, as this web site says.
Tai Chi and Qigong, when taught as mindfulness relaxation therapies can help clear tension blocks, which facilitates a natural healthful flow of Qi or life energy, as well as blood and lymph circulation. Chinese Acupuncture involves 12 Main Meridians, such as the "liver meridian" the "lung meridian" the "kidney meridian" so the gentle massaging of the body, which sets Tai Chi and Qigong apart from other exercises, results also in "massaging the internal organs" and supporting their function and the flow of Qi, or life energy.
The problem I have with meridians is basically the same problem I have with any form of unproven supernatural belief. I include meridians in the broad category of supernatural belief because while life and energy obviously are real, "life energy" in the sense of qi isn't.
Here's part of what the Science-Based Medicine web site says about Chinese medicine:
One of the themes of science-based medicine is to be suspicious of any form of medicine that is not science-based. In other words, beware of dodgy qualifiers placed before “medicine,” such as: “alternative”, “integrative”, or “complementary” – those that imply that something other than science or evidence is being used to determine which treatments are safe and effective.
I would also include “traditional Chinese” medicine in the dodgy category. A recent article defending Traditional Chinese Medicine (TCM) provides, ironically, an excellent argument for the rejection of TCM as a valid form of medicine. The authors, Jingqing Hua and Baoyan Liub, engage in a number of logical fallacies that are worth exploring.
...There is no evidence that the meridians actually exist. At the risk of sounding redundant, they are as made up and fictional as the ether, flogistum, Bigfoot, and unicorns. The linking of qi and blood is reflective of the fact that the notion of qi is historically tied to blood, and techniques such as acupuncture and cupping were also closely related to bleeding techniques that we are more familiar with from Galenic medicine.
Here's the thing. If meridians exist, seemingly they would have some effects in the human body. Those effects should be evident through scientific experimentation. Or some other means. But I couldn't find convincing evidence of this sort.
You may be thinking, what about acupuncture? Well, acupuncture has been found to relieve some types of pain about as well as over-the-counter medications like Tylenol. But there isn't a lot of evidence for the general effectiveness of acupuncture, according to a Scientific American story, "Research Casts Doubt on the Value of Acupuncture."
Studies have found no meaningful difference between acupuncture and a wide range of sham treatments. Whether investigators penetrate the skin or not, use needles or toothpicks, target the particular locations on the body cited by acupuncturists or random ones, the same proportion of patients experience more or less the same degree of pain relief (the most common condition for which acupuncture is administered and the most well researched). “We have no evidence that [acupuncture] is anything more than theatrical placebo,” says Harriet Hall, a retired family physician and U.S. Air Force flight surgeon who has studied, and long been a critic of, alternative medicine.
I've had about a dozen acupuncture treatments for sciatica pain in my right leg. After the first couple of treatments, my pain was much better. However, I have no idea if acupuncture was the cause. The way I express this to my acupuncturist is "I'm not sure if I believe in acupuncture, but I definitely believe in the placebo effect."
She's fine with my attitude, as she never mentions anything associated with Chinese medicine, including meridians. She knows that acupuncture benefits her clients. If that benefit is partly or wholly because of the placebo effect, great. Whatever works. So I keep going for more treatments. Have one tomorrow, in fact. (I wrote about my acupuncture treatments in "I benefitted from my sessions at Salem's Innerhealth Acupuncture Clinic.")
I feel the same way about meridians. My Tai Chi instructor clearly believes in them. I have no problem with that, just as I have no problem with some people in my class being religious. Whatever works for them. If I'm asked whether I believe in meridians or qi or God, I'll answer "No." However, I understand why others believe in entities for which there is no demonstrable evidence. I used to be such a believer myself.
It's only when someone claims that their faith-based belief is true, and expects me to share that belief, that I'll defend my skepticism. Meridians seems to be an example of an unfounded belief that rarely causes harm, though if someone chooses Chinese medicine to cure an aggressive cancer, they definitely are putting themselves at great risk.
The ancients claimed energy (Chi) propagates along the acupuncture meridians and contemporary study specifies electromagnetic waves propagate along the meridians. The waves will revolutionize our thinking about the way acupuncture works. Waves could easily explain the quick response to acupuncture treatments, as well as the human ability to respond quickly – for example, for a split second to figure out where the tennis ball will be and be there to hit it.
Posted by: La Madrugada | September 24, 2024 at 01:27 AM
Brian, animals respond very well when they are treated with acupuncture, only human beings think about placebo, they not...
Posted by: La Madrugada | September 24, 2024 at 01:41 AM
I’ve heard that our NHS (national Health Service) UK uses acupuncture so I checked out the NHS web site. It’s used but seems cautiously. Here’s what they say: -
Western medical acupuncture (dry needling) is the use of acupuncture following a medical diagnosis. It involves stimulating sensory nerves under the skin and in the muscles.
This results in the body producing natural substances, such as pain-relieving endorphins. It's likely that these naturally released substances are responsible for the beneficial effects experienced with acupuncture.
A course of acupuncture is usually recommended because it can take a few sessions for you to see improvements.
The National Institute for Health and Care Excellence (NICE) provides guidelines for the NHS on the use of treatments and care of patients.
Currently, NICE only recommends considering acupuncture as a treatment option for:
• chronic (long-term) pain
• chronic tension-type headaches
• migraines
• prostatitis symptoms
• hiccups
Acupuncture is also often used to treat other conditions and symptoms, including:
• joint and muscle pain
• jaw pain
• cancer symptoms such as pain
• side effects of cancer treatment such as feeling or being sick from chemotherapy
• feeling sick or being sick after surgery
However, the evidence on the effectiveness of acupuncture compared with other treatments is unclear.
I think I'd give it a try - perhaps as a last resort.
Posted by: Ron E. | September 24, 2024 at 02:09 AM
La Madrugada, I'm open to the benefits of acupuncture. After all, I'm having my 13th treatment today. But research has shown that it doesn't matter if needles are inserted along supposed meridians. So any benefit from acupuncture doesn't come from balancing qi life energy.
A veterinary web site has information about pet acupuncture that seems reasonable. Here's a link and some excerpts:
https://vethelpdirect.com/vetblog/2023/05/07/acupuncture-whats-the-evidence/
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In short, there are lots of preliminary studies demonstrating the effectiveness of acupuncture, but rigorous scientific studies are lacking. This does not disprove acupuncture, but we have not fully proved it’s efficacy either. Empirical evidence from thousands of patients seem to imply there is some benefit to acupuncture; but this may be exaggerated by the placebo effect. We agree that to ignore thousands of years of knowledge seems foolish, but always take the claims surrounding acupuncture with a pinch of salt, particularly when it comes to dogs, cats and other animals.
...While many studies have shown some beneficial effects, literature reviews claim that a lot of these studies do not hold up to scrutiny. This may be due to small study size, lack of proper controls, high variation within a study, overinterpretation of data or even bias. Studies in animals are even more scarce, making it harder to judge whether it is appropriate to perform in animals.
...Non-specific effects are those with no apparent explanation. These may be due to the patient’s belief in the treatment (the placebo effect), and this has been shown in studies with humans. Though the placebo effect has been shown to exist in animals, especially dogs but also cats, horses and other pets, often the placebo is from the owner; the owner believes the animal is healthier even when they are not. This may be dangerous as it can result in the animal not being treated properly.
Posted by: Brian Hines | September 24, 2024 at 10:22 AM
🙄🙄🙄 please
You don’t know what you don’t know.
Posted by: Scienceiseverevolving | September 25, 2024 at 06:24 AM
Makes no sense.
You say acupuncture meridians are bs, and also say you'll continue to pay $ for acupuncture because of the placebo effect.
The placebo effect requires belief. Belief not only in the treatment's efficacy, but also belief in the causative factors of the treatment. In an acupuncture treatment, that causative factor is based on meridian theory.
"It's only when someone claims that their faith-based belief is true, and expects me to share that belief, that I'll defend my skepticism."
But you're not doing that. You're saying a certain medical treatment isn't true, and at the same time saying that you'll keep doing it. You're also saying that anything that's based on faith is hogwash, but also saying you believe in hogwash medical treatments that are based on nothing but faith.
You're not making strong arguments here.
"Meridians seems to be an example of an unfounded belief that rarely causes harm, though if someone chooses Chinese medicine to cure an aggressive cancer, they definitely are putting themselves at great risk."
True, but that's neither here nor there.
You have a physical problem, you went to a provider that offers meridian therapy, and you say the treatments provided almost immediate relief -- and yet you're adamant that this couldn't be related to meridians. You say it was related to your faith in the treatment, but also say you have no faith in the treatment. Why not say instead, "gee, maybe we do have meridians and they are effective for pain relief" instead of this contradictory stance on the matter.
Posted by: sant64 | September 25, 2024 at 09:15 AM
"The placebo effect requires belief."
Nope. You've no clue what the placebo effect is, s64, if you think that.
Posted by: Appreciative Reader | September 25, 2024 at 10:20 AM
sant64, as I said in this post, my acupuncturist never mentions meridians. Yesterday I asked her about meridians during my treatment session. She said that the meridians follow the paths of nerves. Sometimes when she inserts a needle in one place I feel a tingle in another place. When that happens I say "good one" because to me it shows that the needle is having a discernible impact on a nerve.
My insurance covers acupuncture for 12 sessions a year. As I mentioned in the post, acupuncture has been shown to relieve sciatica pain to some extent, which is why I started acupuncture treatments. You assume that meridians have to be real for acupuncture to work. That's a false assumption as I thought I made clear in this post. There can be other reasons why acupuncture helps relieve pain other than tapping into meridians. Tapping into nerve channels is one reason, the placebo effect is another reason, simple stimulation via the minor pain of the needles could be another reason.
Posted by: Brian Hines | September 25, 2024 at 10:25 AM
Appreciative Reader, you're correct. Placebos involve much more than belief. A recent Harvard Medical School article makes this clear. Here's a link and a few excerpts:
https://www.health.harvard.edu/newsletter_article/the-power-of-the-placebo-effect
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Your mind can be a powerful healing tool when given the chance. The idea that your brain can convince your body a fake treatment is the real thing — the so-called placebo effect — and thus stimulate healing has been around for millennia. Now science has found that under the right circumstances, a placebo can be just as effective as traditional treatments.
The placebo effect is more than positive thinking — believing a treatment or procedure will work. It's about creating a stronger connection between the brain and body and how they work together.
....How placebos work is still not quite understood, but it involves a complex neurobiological reaction that includes everything from increases in feel-good neurotransmitters, like endorphins and dopamine, to greater activity in certain brain regions linked to moods, emotional reactions, and self-awareness. All of it can have therapeutic benefit. The placebo effect is a way for your brain to tell the body what it needs to feel better.
But placebos are not all about releasing brainpower. You also need the ritual of treatment. When you look at these studies that compare drugs with placebos, there is the entire environmental and ritual factor at work. You have to go to a clinic at certain times and be examined by medical professionals in white coats. You receive all kinds of exotic pills and undergo strange procedures. All this can have a profound impact on how the body perceives symptoms because you feel you are getting attention and care.
...Placebos often work because people don't know they are getting one. But what happens if you know you are getting a placebo?
A study published in Science Translational Medicine explored this by testing how people reacted to migraine pain medication. One group took a migraine drug labeled with the drug's name, another took a placebo labeled "placebo," and a third group took nothing. The researchers discovered that the placebo was 50% as effective as the real drug to reduce pain after a migraine attack.
The researchers speculated that a driving force beyond this reaction was the simple act of taking a pill. People associate the ritual of taking medicine as a positive healing effect. Even if they know it's not medicine, the action itself can stimulate the brain into thinking the body is being healed.
How can you give yourself a placebo besides taking a fake pill? Practicing self-help methods is one way. Engaging in the ritual of healthy living — eating right, exercising, yoga, quality social time, meditating — probably provides some of the key ingredients of a placebo effect.
While these activities are positive interventions in their own right, the level of attention you give can enhance their benefits. The attention and emotional support you give yourself is often not something you can easily measure, but it can help you feel more comfortable in the world, and that can go a long way when it comes to healing.
Posted by: Brian Hines | September 25, 2024 at 01:10 PM
Uhhhm, pardon me, Brian, but I’m afraid I find myself disagreeing, tentatively, with some of the details of that ---- while agreeing, absolutely, with the overall thrust of your comment to me. …Tentatively, because your cited article does bear out, exactly, what you’ve said; and what’s more, although it isn’t a research paper but only an opinion piece, but nevertheless it’s a Harvard thing, and written by their medical editor, so certainly not some crank thing. And I don’t have any references at hand just now myself, so that this is not a defense per se of what I’m saying, but simply a statement of what I believe the placebo effect amounts to, and where my impression differs from what you’ve said.
With the tentative and essentially unsupported nature of my disagreement clearly stated, here’s where I was coming from, here’s what is my impression of this placebo effect thing:
(And no doubt you’re aware of all of this, Brian, but I’ll still spell this out fully in order to make what I’m saying fully coherent.)
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First, what’s placebo: Typically when you have medical trials, then you’ll have three groups: One group that’s administered the medication being tested for, a second group that’s administered no treatment at all, and a third group that’s administered a pretend-treatment. And that last, the pretend-treatment, the glucose pill, the glucose injection, whatever, that’s what’s referred to as the placebo.
Second, how treatment efficacy is ascertained: The first question is, has the group the group that’s been administered the actual treatment shown any improvement? If the answer’s No, then that’s the end to it. But even if the answer’s Yes, even so, that does not necessarily mean the treatment’s effective. Next the improvement experienced by this group is compared to the improvement reported by the other two groups, if any. Only if the improvement reported for the group that has been administered the actual treatment, is statistically greater than the improvement than the improvement reported for the other two groups, only then do we conclude that the treatment’s been effective.
…Sorry for going into such detail about this basic stuff! I’m perfectly sure you’re fully aware of all of this, like I said I just wanted to make my thoughts, and my comment, fully coherent, is all.
So now, moving on to: Third, what is the placebo effect: The placebo effect is, quite simply, the improvement specifically along the parameters being tested, that’s reported by the group that was administered the placebo treatment or placebo medication. …So that “placebo effect” is simply a catch-all term for all of those things that haven’t been explicitly controlled for in the study.
What are all of those things that make up the placebo effect? We don’t know, and that’s the point! If we did know, then we’d have controlled for them. It could be something in the medium of the pill within which has been inserted the inert pretend-medication. It could be something in the pretend-treatment that’s happened to have produced results. It could be …anything. The point is, to compare this with the actual treatment results, to see if the latter actually works or not.
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Heh, again, sorry for gabbing on and on about this very basic thing! My point is, given this, acupuncture is NOT placebo effect. Here’s why:
Does acupuncture actually work? I personally don’t know! But the only way anyone can possibly know, is by actually carrying out proper, controlled trials of acupuncture. Should those controlled trials of acupuncture show that acupuncture delivers better results than both the no-treatment group as well as the placebo-group: then yes, acupuncture works. And if the acupuncture-group does not report better results than the placebo-group and the no-treatment-group: then no, acupuncture does not work.
(Incidentally, and somewhat at a tangent: Agreed 100% with you, even if acupuncture is seen to work, as above, even then that most certainly does not mean there’s any basis to this whole Meridian thing. As you say, it could be neural pathways, or whatever other mechanism --- most certainly it wouldn’t be a support for any kind of alternative medicine nonsense, or of these Meridians, or of Chakras, or whatever.)
Coming back to what I was saying: Does acupuncture work? I personally don’t know, but either it does, or it does not, and which it is can be determined by looking objectively at actual research, actual studies, proper controlled trials. …I know your doctor suggested it might work, I know your insurance covers it, and Ron has said that NHS over in the UK offers it as well: but none of that is conclusive, really. After all, UK NHS used to offer homeopathic treatment until fairly recently; and some doctors are sometimes kind-of-sort-of supportive of homeopathic treatment as well: but that does not make homeopathy an effective treatment for anything.
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I’m saying, the only way to ascertain if acupuncture actually works, is to see whether there have been any controlled trials of acupuncture, and what the results of those trials are. And regardless of whether acupuncture is shown by such trials to work, or to not work: but, either way, there’s no way this can be put down to “placebo effect”!
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So, like I said, obviously I agree 100% with the broad thrust of your comment, Brian. But I’m afraid I find myself disagreeing --- ever so tentatively, because like I said all of this is just my impression, that I’m not able to actually support with citations etc at this point --- with some of the details of what you say. Particularly when you say this: “The placebo effect is a way for your brain to tell the body what it needs to feel better.”
Like the article says, the mechanism isn’t quite known. So if the mechanism isn’t known, then how can one conclude that it is the brain telling the body what it needs to feel better? We simply don’t know what it is. It could be simply suggestibility; and it could be simply the FOMO thing, the not-wanting-to-disappoint thing; that combination that is sometimes known to explain mass-delusion/mass-hypnotism. It could be some other perfectly reasonable and entirely material thing that one hasn’t uncovered. Or it could be the brain-directing-the-body thing. Or it could be past-life karma. Or it could be whether one’s name starts with a vowel or a consonant. Or …it could be anything at all, one can speculate anything at all, sometimes at random, sometimes with some basis: but it’s no more than speculation, unless it gets tested and proven.
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Sorry, that ended up a long and somewhat rambling comment. Like I said, I agree with your broad thrust, but find myself unable to agree with some of the details in what you say; or indeed with some of what this article says: while fully realizing the iffiness of saying all of this without actually backing it up.
Posted by: Appreciative Reader | September 26, 2024 at 10:28 AM
Re-readig what I'd said earlier, let me summarize my (tentative) disagreement, a TLDR thing as it were: Three points, basically:
1. Does acupuncture work? Well, is there any controlled study that shows it does? Even if for some limited categories of cases, like pain? ...If so, let's clearly and unequivocally recognize it works. If not, let's clearly and unambiguously reject it. (I was under the impression it doesn't work. Same as homeopathy, even though some bona fide institutions sometimes do suggest homeopathy.)
2. Sure, belief in some bona fide treatment cannot be a prerequisite for that treatment to work. Agreed 100% with you there. Reality is that which does not wilt away and disappear into nothing when you stop believing it.
3. Is brain-directing-body-to-heal, via belief not direct instinct, via feels not direct instinct, ever a thing? Is there any controlled study showing this works? If there is, then let's clearly and unambiguously recognize it works; else let's clearly and unambiguously reject it. (I was under the impression that it doesn't work.)
4. Placebo isn't, as I've seen that term used, anything like how it seems to have been implicitly defined in the Harvard article. I'm pretty clear what placebo effect means, and I've discussed it here. So, it's one of these three, and I'm not sure which:
(a) I'm wrong about what placebo means, and they're right.
Or else, (b) They're mistakenly using placebo in that sense, and my usage is the correct one.
Or else, (c) Although one usage is not like the other, but both usages are correct, in different contexts.
...This last, #4, is merely matter of definitions. I'm not sure which of these three is options is the case. Maybe (c), but I don't know really.
Posted by: Appreciative Reader | September 26, 2024 at 05:26 PM
Ehh, *four* points, not three!
Posted by: Appreciative Reader | September 26, 2024 at 05:27 PM
Appreciative Reader, there's a review of the literature on acupuncture for treating sciatica pain that came to some possibly promising conclusions. I'll share a link and the abstract.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4631886/
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This is a systematic review and meta-analysis, which aimed to assess the current evidence on the effects and safety of acupuncture for treating sciatica. In this review, a total of 11 randomized controlled trials were included. As a result, we found that the use of acupuncture may be more effective than drugs and may enhance the effect of drugs for patients with sciatica, but because of the insufficient number of relevant and rigorous studies, the evidence is limited. Future trials using rigorous methodology, appropriate comparisons, and clinically relevant outcomes should be conducted.
Posted by: Brian Hines | September 26, 2024 at 11:54 PM
@ Brian
Your stance in the picture is different from the others.
Is it an visual distortion or your factual [Taj Chi] stance?
Posted by: um | September 27, 2024 at 05:35 AM
Enjoyed going through your comment, and the report you linked to.
Absolutely, this seems to settle the matter. Basis this, certainly we can provisionally take it that acupuncture does work, at any rate for pain relief in sciatica even if not necessarily for anything else.
Thanks very much, Brian, for correcting what I see now was a glaring misapprehension on my part! I was under the impression that acupuncture is equally as unevidenced as other “alternative medicine” interventions like homeopathy and Reiki and Chakric healing, when that is clearly not the case.
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The meta-analysis seems to have been done very scrupulously. They ruthlessly weed out very large swathes of their original meta-sample when those come up short; and they very clearly highlight the shortcomings in the results they’ve arrived at. Like they point out, their conclusion isn’t definitive, and there’s more research needed. …But nevertheless, the results are clear enough, so far as this meta-study goes: and it does go far enough, I think, for us to weigh in clearly on the side of acupuncture as far as this specific (pain relief in sciatica).
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Heh, here’s an amusing aside that I noticed:
The “placebo effect” for this study was remarkably high! Not that that’s an issue: the difference in acupuncture results vis-à-vis placebo results --- “placebo results”, in the sense that I had defined it in my earlier comment, which is to say the sham-treatment results --- was statistically significant, which is why they conclude what they do; so that’s not an issue here, at all. Just, I found it interesting, given the larger context of the discussion on placebos, that the placebo scores so remarkably well, and so very close to the actual treatment results, in the instance they highlight (22/30 vs 29/30)!
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And of course, while settling the matter as far as acupuncture and sciatica pain relief; but this still leaves wide open the matter of placebos generally. And I’m afraid I continue to favor my own more commonsense approach and interpretation of what it represents, over the way more extravagant (and, as far as I can see, completely unevidenced) brain-directing-the-body interpretation of placebo, even despite the Harvard link.
Posted by: Appreciative Reader | September 27, 2024 at 10:27 AM