Talk:Acupuncture

Origin

which part of the following text suggest/explains that "Acupuncture's origins in China are uncertain"? Shang Dynasty (1600–1100 BCE) is a dynasty in China. "Acupuncture's origins in China are uncertain" is ambiguous.

Acupuncture's origins in China are uncertain. One explanation is that some soldiers wounded in battle by arrows were believed to have been cured of chronic afflictions that were otherwise untreated,[37] and there are variations on this idea.[38] Sharpened stones known as Bian shi have been found in China, suggesting the practice may date to the Neolithic[39] or possibly even earlier in the Stone Age.[40] Hieroglyphs and pictographs have been found dating from the Shang Dynasty (1600–1100 BCE) which suggest that acupuncture was practiced along with moxibustion. — Preceding unsigned comment added by 69.159.47.75 (talk) 17:31, 14 January 2012 (UTC)

Lede: Existence of TCM concepts

In my understanding, this article is about the cultural phenomenon of acupuncture. Apart from informing the reader about A: "what this phenomenon actually is", a thorough encyclopedic article naturally should also inform about B: "what are the pros and cons about it?". But if we rush to B before properly laying down A, we get what we have here with the bracketed sentence in the lede: it sounds awkward and overzealous. Therefore, I recommend to delete it. The lede puts too much weight on the pros and cons of acupuncture already (but that's a problem we save up for later). --Mallexikon (talk) 04:44, 18 November 2011 (UTC)

No, the page is about acupuncture, period. Though a definition is important, so is the research. Also note that the sentence is now different, not bracketed and juxtaposed with the statement that many practitioners don't practice according to TCM. To have one page on "cultural phenomenon" and another on research, particularly when the research doesn't really support acupuncture, is to engage in content forking and that is not appropriate. Though the historical basis of acupuncture is important, the modern research is lively and ongoing, an increasingly large body of knowledge that is a hugely important part of acupuncture's use in modern society. The research can not be shunted or diverted to a separate page or ghettoized into a single "criticisms" section. Giving readers the impression that acupuncture is an old and sophisticated system without acknowledging that the system has failed to be validated by empirical testing is not appropriate. WLU (t) (c) Wikipedia's rules:^simple/_complex 11:25, 18 November 2011 (UTC)

WLU your absolutism is discouraging improvement of the article. Please seek consensus rather than playing the role of a judge. Mallexicon is making some important points and we should discuss them further.Herbxue (talk) 19:10, 18 November 2011 (UTC)

The overwhelming, site-wide consensus is that WLU is correct. This consensus is laid out in guidelines such as WP:DUE, WP:FRINGE, and WP:CFORK. Local consensus cannot override that. WLU is working collaboratively and civilly within our existing content policies, and accusing him of combatively stunting the article is uncalled for. If you have a problem with another editor, please see WP:DR.   — Jess· Δ♥ 19:28, 18 November 2011 (UTC)

I'm not really buying into that "trust me, we know better, you have to do it this way" story. Consensus on this article's content needs to be hashed out here. WLU is not the arbiter of consensus, even though he is a really competent and collaborative editor. Even the best editors have been know to occasionally wikilawyer to advance a POV, no?

I do not see anyone trying to remove all criticism of acupuncture, and although I recommend a separate article on the contentious and messy topic of acupuncture research, I have never recommended removing all scientific research from this article completely. Please stop implying that that is what is being suggested. Still, the very fact that the issue of weight balance between description and criticism keeps coming up is a clear sign that consensus has NOT been reached.Herbxue (talk) 23:13, 18 November 2011 (UTC)

Obviously, the content of this article needs to be discussed on this page. I don't think anyone suggested otherwise. However, we absolutely cannot, even with local consensus to do so, violate a policy like WP:CFORK by separating the scientific view of acupuncture from the "cultural view", nor can we violate policies like WP:FRINGE and WP:DUE by pushing the criticisms out of the lead, and de-emphasizing their significance. Accusing WLU of being disruptive for pointing this out is unhelpful, and creating a "pro-acupuncture vs anti-acupuncture" mentality. You're welcome to see WP:DR if you have problems with that - an RfC could be helpful for instance - but a couple of editors here can't just decide to IAR away WP:NPOV.   — Jess· Δ♥ 01:38, 19 November 2011 (UTC)

Guys, please, come out of the trenches. My apologies if I didn't sound clear about this. I have not been suggesting to split this article when I talked about A and B. Of course and obviously the question (and research) about efficacy has to be a very important part of the acupuncture article. My concern right now is merely about the lede and the awkward impression it gives when it has to mention that "scientific research has failed to validate the existence of any of the TCM concepts" already in the very third sentence. Could me maybe at least move that sentence to the second half of the lede, where efficacy/criticism is discussed? --Mallexikon (talk) 06:31, 19 November 2011 (UTC)

Please note that I consistently cite policies, guidelines and sources to substantiate my points. Please do the same to substantiate yours. Claiming my suggestions and edits don't "improve the article" is invalid given my consistent integration of new sources and information in line with the P&G. I may not move it towards the version preferred by editors who believe acupuncture is a valuable and effective medical intervention, but your issue is with the sources, not with me.

The fact that the weight balance between description and criticism keeps growing is due to the fact that I keep discovering more and more criticism the more I dig. This suggests that "criticisms" (which is really scientific testing which fails to validate TCM concepts) are a large and vivid part of the research on acupuncture. The failure of science to validate TCM concepts should appear juxtaposed with the first discussion of those very concepts, and IMO should appear quite early. I believe this is a fairly routine editing decision and the only purpose to moving it to a later part of the lead would be to reduce criticisms of acupuncture - a violation of neutrality. WLU (t) (c) Wikipedia's rules:^simple/_complex 12:58, 19 November 2011 (UTC)

Ok, I apologize for the attack on WLU, which I mistakenly thought was pretty mild. I have no time to learn how to paste fancy policy links in my posts, but I've read them, including fork, and I think they all basically back up common sense. For the last time - I never ever said take out all the criticism from the main article. In fact, I want the research given even more space in a separate article. Its not a violation of fork guidelines if the subject is large and complex enough to warrant a spin-off article - and acupuncture research is certainly a large enough issue. Skeptics like to think that the doubts and uncertainty in the literature can be summed up in a neat little box - that acupuncture is just placebo - but the reality is more complex. I think that complexity deserves to be represented properly.

Also, I support what Mallexikon is suggesting above. I understand what WLU is saying about NPOV, but disagree that every single sentence needs an awkward tit-for-tat negation.Herbxue (talk) 21:38, 19 November 2011 (UTC)

Having two articles on the topic is not a violation of WP:CFORK, but having one for criticism and another devoid of criticism is. Your proposal (however you decide to phrase it), fits into that problem area: one for science and another for "culture"; one history and another "modern practice"; one "practice" and another "pros and cons". These proposals all aim to discuss the claims of acupuncture in one place, and push the scientific criticism to another separate area. As WLU has pointed out, the scientific criticism of acupuncture is a rich part of this topic, and it deserves necessary weight alongside acupuncture's claims per WP:DUE. We could have two articles, but we'd need scientific reception of the topic in both.   — Jess· Δ♥ 22:05, 19 November 2011 (UTC)

Herbxue, I didn't read your post as an attack (or if it was one, I've seen far, far worse so no worries). Thanks for the apology, it wasn't necessary but I appreciate it anyway. I realize this is frustrating but the reason I keep pointing to policies, guidelines and sources is because they are what wikipedia is based on and without them we are anarchopedia (there's a reason they've only got 200 articles and we've got several million). If anyone can show that my actions are inappropriate per the policies and guidelines, or that I've mis-interpreted a source, I will do my best to correct it. But please realize my standard is always those three things.

As far as spin-off articles, the main page is a roll-up of daughter articles the way the lead is a roll-up of the body of an article. The significant points in parent articles are elaborated on in daughter articles, or the complexities of daughter articles are summarized (per WP:SS) in parent articles. It's not simply a matter of content forks and ghettoizing criticisms, it's also the fact that the articles themselves should show relationships in terms of what they cover. If a point is controversial in a daughter article, the parent article gives a brief overview of the controversy.

Mallexikon, why is the presentation of the lack of scientific validation of TCM "awkward"? Is it because of the wording? Because structurally, in my mind it makes a lot of sense to put the two together. Otherwise the reader will work through a paragraph of text, get the impression that acupuncture has some sort of theoretical basis, only to have to read in another paragraph that none of the theory can be substantiated. Most controversial or discredited topics note quite early that the topic is controversial or discredited. Written from a solely TCM-practitioner perspective the page may give too much credit to the scientific skepticism, but read from a scientific skepticism perspective it spends far too much time on prescientific magical concepts that there is no real reason to expect any sense from (much like the humoural theories of the Ancient Greeks, or the magical medicine of the Egyptians). WLU (t) (c) Wikipedia's rules:^simple/_complex 01:50, 20 November 2011 (UTC)

While it would not be right to pretend that many of TCM's theories, like "Qi" or "Essence" are unique, physically identifiable entities, I would recommend broadening your understanding of the phenomena they are an attempt to describe. For example, you might say that there is no such thing as "Yin" or "Yang", but these are relative concepts that describe things as they relate to other things. Qi is not as clean an example, but still to say that "Qi" does not exist because it is not a unique thing (like atoms) or energy (like heat) kinda misses the point of why people continue to consider it a useful concept. To the acupuncturist, heat is one manifestation of qi, nerve propagation is another; lack of of gastric secretion is a deficiency of qi in the digestive system, and so on. Its not a thing but a description of many phenomena. The reader would not have a chance to start to understand this thought process if every single term is immediately treated from a reductionist viewpoint. That viewpoint needs to be included, but describe the thing it refutes first.Herbxue (talk) 03:03, 20 November 2011 (UTC)

The thing is, I can't just read up on something and write it up. I would need to cite sources. If someone says that qi is not meant to represent an actual entity, then we need that person saying it in a source, and we need to cite that source. If you have these sources, I strongly urge you to integrate them! I have read comments like yours before, but I don't remember where, and I'm really not that interested in finding them again or reading an entire book on the subject. I have zero objections to this information being in the article (including the lead) but I have to insist it is attached to a source or I will remove it per WP:PROVEIT. I've said this before Herbxue, neither you, nor I, can use our own opinion as a source - we need a book, journal article, web page from a reliable publisher, etc. In order to integrate this information, someone needs to look on google books, google scholar, or just plain google. I would also suggest revisiting WP:RS for a common understanding of what "reliable" means. If you don't feel like integrating it, provide me with the publication and page number and I'd be happy to do it.

Also, just because there are those that use qi as a metaphor for actual metabolic processes doesn't mean we get to claim effectiveness; saying a deficiency of qi in the stomach is an analogy for low gastric secretions doesn't obviate the need to say testing has not supported acupuncture's ability to increase gastric secretions. WLU (t) (c) Wikipedia's rules:^simple/_complex 15:15, 20 November 2011 (UTC)

I think Herbxue has a very good point, there, and just out of goodwill, you could take a look at our section dealing with qi, where it says: "...qi is something that is defined by five cardinal functions..." (it's sourced). Then again, WLU has a very good point here, too. If we want to state the point that most of these TCM entities like yin, yang, qi, the zang organs etc. are abstract entities only defined by their postulated functions, we need sources to verify that. So should I maybe transfer this:

"TCM's view of the human body is only marginally concerned with anatomical structures, but focuses primarily on the body's functions[40][41]... These functions are aggregated and then associated with a primary functional entity - for instance, nourishment of the tissues and maintenance of their moisture are seen as connected functions, and the entity postulated to be responsible for these functions is xuě (blood)[42] - but this is mainly a matter of stipulation, not anatomical insight.[43]"

from the TCM article? --Mallexikon (talk) 03:09, 21 November 2011 (UTC)

I'm willing to accept Herbxue's point, provided there are sources. My objections are continually based on the lack of adequate sourcing, not an abstract opposition to TCM (wikipedia is about verifiability, not truth). If there are sources, I want to be sure they are reliable, and I want them to be summarized accurately - that's as far as my concerns go.

Are we still talking about the lead? I don't think we should get into a lot of detail in the lead, I think the current version adequately summarizes the broad-strokes TCM concepts and the lack of scientific justification. If more detail is required in the body, I'm OK with that. WLU (t) (c) Wikipedia's rules:^simple/_complex 16:42, 21 November 2011 (UTC)

That's all fine but my concern right now is with the lead. This sentence: "Scientific research has failed to validate the existence of any of the TCM concepts" has multiple issues which I hope we don't have to discuss here. Can we get a quick solution by consenting to changing it to "scientific research has failed to find physical equivalents for qi, meridians, and acupuncture points"? --Mallexikon (talk) 04:31, 22 November 2011 (UTC)

There has been no modern verification of any aspect of the concepts as far as I know. "Physical equivalents" implies that there are non-physical equivalents that justify TCM concepts. As far as I know there are none. I understand that people want to believe the Chinese discovered, despite lacking empirical testing, dissection, microscopes and chemistry, some sort of modern understanding of the body - but the evidence just isn't there. They invented an oriental version of Greek humourism that, like most pre-modern societies, is mystical rather than rational. Qi bears no resemblance to any actual modern understanding of anything I've seen - acupuncture at best reduces pain and nausea, though possibly only through placebo. It doesn't have any effect on disease that I'm aware of, only to symptoms highly amenable to placebo. Are there any "non-physical" equivalents that I've not seen yet? WLU (t) (c) Wikipedia's rules:^simple/_complex 11:23, 22 November 2011 (UTC)

One problem is the lumping of all TCM concepts together, and claiming that lack of science on one part = no evidence for any part. For example, a red sore throat would be labeled a "heat pattern" in TCM and treated with "cold herbs", in modern medicine it may be labeled and infection or inflammation and treated with antibiotics or NSAIDs. Both work very well. Some have tried to argue that "heat" = "inflammation" or "infection" but it is not really true and probably not even helpful. But many of the "cold" herbs also happen to have antibiotic or anti-inflammatory actions. So, is the TCM concept validated by the science? Or do you conclude that the "mystical" idea of treating hot with cold was a lucky guess? I know you hate to hear this, but the fact that TCM speaks a different language and is based on different assumptions poses a real problem for us and requires that we not make overly simplistic statements based solely on the modern medical model.Herbxue (talk) 21:19, 22 November 2011 (UTC)

What evidence is there for any concepts? Again, none of this debate really matters in the absence of sources. What specific sources support specific TCM concepts? What sources support "cold herbs" having antibiotic or anti-inflammatory properties? What sources support a "heat pattern" being inflammation (aside from the trivial observation that inflamed areas are warm)? Without sources, these abstract discussions are pretty pointless. If a reliable source echoes your assertion, for me the only real question becomes how to summarize it.

The assertion that TCM is speaking a different language rather than simply "right by accident" is also an assertion that requires a source. All prescientific medicine usually manages to be correct about certain herbs, be they emetics, analgesics, laxatives or soporifics, but that doesn't validate the medical system. And if we're debating the modern medical model, when modern medicine was introduced to China I believe that, like all nations, they experienced a considerable boom in longevity, a drop in infectious diseases and a much higher rate of survival out of childhood. Mao brought back TCM for political reasons, not because it was as effective as vaccinations, surgery and drugs.

But again - to be integrated into the page, sources are required. WLU (t) (c) Wikipedia's rules:^simple/_complex 22:48, 22 November 2011 (UTC)

But now we're discussing efficacy again, which is a totally different topic. The sentence as it stands is semantically wrong as it states that the TCM concepts are not existing. But of course they are existing (we are dealing with them/discussing them right now) - a concept is something abstract after all. The question is whether these concept have an equivalent in the real/physical world. But instead of discussing philosophy here we should take a look at whether this semantically wrong sentence is really supported by its sources - and when I checked the sources that are accessible online, I couldn't find that they do. Could you point out the supporting quotes to me, please? --Mallexikon (talk) 03:21, 23 November 2011 (UTC)

“ Despite considerable efforts to understand the anatomy and physiology of the "acupuncture points," the definition and characterization of these points remain controversial. Even more elusive is the scientific basis of some of the key traditional Eastern medical concepts such as the circulation of Qi, the meridian system, and other related theories, which are difficult to reconcile with contemporary biomedical information but continue to play an important role in the evaluation of patients and the formulation of treatment in acupuncture. ”

“ Of course, the existence of qi has never been demonstrated in any sort of scientifically acceptable manner and perhaps never will. Without being able to scientifically validate the existence of qi, the traditional rational for acupuncture and Chinese medicine will never receive modern science’s seal of approval no matter how many clinical trails show effectiveness in treating disease. The combination of mounting evidence of acupuncture’s clinical effectiveness together with an inability to scientifically validate its traditional rational has lead to a new and rapidly growing class of acupuncture supporter; those who acknowledge acupuncture’s clinical value while disavowing its traditional rational. This new breed of supporter is beginning to do more to undermine long-held notions about Chinese medicine than all the sceptics who doubted its effectiveness combined! ”

“ Based on this review, the evidence does not conclusively support the claim that acupuncture points or meridians are electrically distinguishable ”

Mann also makes somewhat similar points, but obviously more complicated to summarize. Trick or Treatment does make this point I believe, but google books doesn't have a preview anymore. I'll request it from the library. Matuk wasn't a good choice as a reference, I've removed it. I've adjusted the wording to refer to a lack of link between any TCM concept and any biological structure or function. If anyone is going to claim that there is such a link or that TCM is a valid framework for diagnosis or treatment, I'd really, really like to see the source this is based on before discussing further. WLU (t) (c) Wikipedia's rules:^simple/_complex 17:29, 23 November 2011 (UTC)

Fair. Regarding your wording, I think it's very good. I'll just change "TCM concepts" to "the concepts of qi, meridians, and acupuncture points" because that's what is supported by the sources, and it also goes smoother with the preceding text. The problem with "TCM concepts" as a whole is that this includes things like yin/yang and the Five Phases - to write that science couldn't come up with an anatomical/biological/functional equivalent to these philosophical/abstract concepts is probably true, but IMO smells of tautology. Altogether, I'd still have preferred to position the criticism a few lines further down, but that's a mere matter of style; and as it is now, it feels smooth. Cheers, --Mallexikon (talk) 10:14, 24 November 2011 (UTC)

@Famousdog: yes, that's even better wording. Thanks, --Mallexikon (talk) 02:57, 25 November 2011 (UTC)

I got Trick or Treatment out from the library and it does indeed verify this point. WLU (t) (c) Wikipedia's rules:^simple/_complex 18:37, 3 January 2012 (UTC)

To claim that "Scientific research has not found any physical or biological correlate of qi, meridians and acupuncture points" is wrong. Am J Chin Med. 2005;33(5):723-8. finds 'Differences in electrical conduction properties between meridians and non-meridians.'

" The current conduction and potential profiles were compared after switching the current direction in the Hegu (LI-4) and Quchi (LI- 11) meridians and over a non-acupuncture point 1 cm from Quchi (LI-11) in 20 healthy subjects. Both meridians demonstrated significantly higher conductivity between Hegu (LI-4) and Quchi (LI-11) than between Hegu (LI-4) and the non-acupuncture point. The direction of current, peak frequency and absolute potential values in the direction Hegu (LI-4) to Quchi (LI-11) differed significantly from those in the direction Quchi (LI-11) to Hegu (LI-4). These results suggest that the conducting pathways are stronger in the meridians than in the non-meridians and that preferential conduction directions exist between two acupuncture points. These results are consistent with the theories of Qi-circulation and traditional Chinese medicine."Dickmojo (talk) 14:09, 30 January 2012 (UTC)

Indeed the source 5 listed to back this in the text after this quote itself says in relation to the electro-conductivity of meridians that "the findings are suggestive". Surely for balance this view ought to be alluded to.Dickmojo (talk) 00:03, 31 January 2012 (UTC)

Ok, so I just amended the text to include this part of source 5. Now to pre-empt any knee-jerk reaction by sceptics to automatically revert it out of hand, let me say that we are not here to *debunk* acupuncture. Well I mean, you guys are, but that is contrary to the spirit of WP. What we should actually be here to do is give a balanced and rounded summary of the various viewpoints out there, and it is a mainstream view amongst many acupuncturists that acupoints and meridians do have electro-conductivity properties. This is not a fringe view, and there is acceptable secondary evidence which is suggestive of such, so I don't think it should be reverted without due discussion.Dickmojo (talk) 13:27, 31 January 2012 (UTC)

I agree, and although there are questions about the research on conductivity, we should present sources that both confirm and fail to confirm any difference in conductivity on channels in order to present the current state of the research accurately.

One big difference for me, however, is that I think this issue is better discussed under the "Possible Mechanisms" section. I think the idea of debating the "existence" of TCM concepts is unfruitful. To argue whether Qi is a distinct force or material really misses the point of why it continues to be a useful concept.Herbxue (talk) 19:15, 31 January 2012 (UTC)

Wrong. See WP:MEDRS. PMID 16265984 is a primary source that should not be used on the page, particularly when a secondary source (PMID 18240287) that was published three years later concludes there is no good quality evidence to support the existence of meridians. WLU (t) (c) Wikipedia's rules:^simple/_complex 20:58, 31 January 2012 (UTC)

Primary sources are not to be used to make medical claims (efficacy claims). This is not an efficacy claim. Thats why I think it should be discussed under possible mechanisms.

If the preponderance of evidence fails to show any anatomical, electrical, or other distinctiveness of meridians vs. non-meridians then the article should certainly say that, but that is not equivalent to saying they do not "exist" because they exist as a concept that is taught, studied, and tested on for entry to the profession, and as a tool used in practice.Herbxue (talk) 22:02, 31 January 2012 (UTC)

See WP:PSTS. Doesn't matter if it's a medical claim or not, the secondary source takes precedence in terms of age, reliability and policy. MEDRS is explicit about it, but the same statement applies - review articles take precedence over low-n studies and the latter can not be used to contradict the statements made in the former. Positive claims must rest on positive evidence, it's sufficient to note that traditionally acupuncture's mechanism is points, meridians and chi and that no good evidence has been found for any. We can note that people believe they exist, but must also mention that there's no actual evidence for it. In fact, per WP:STRUCTURE the current section discussing the lack of support for points, chi and meridians should be moved to the same section discussing their traditional alleged mechanism. WLU (t) (c) Wikipedia's rules:^simple/_complex 22:43, 31 January 2012 (UTC)

If we are to mention in the lede that there is no scientific evidence for the existence of qi, acupuncture points and meridians, then we must ALSO mention that there is research which is suggestive of the electro-conductivity properties of acupuncture points and meridians, or else we are concealing parts of the broader picture and are in violation of NPOV. Either delete that sentence entirely or restore my qualifier. C'mon now! There's a link to the source, let people read it and make up their own minds! Don't try to hide parts of the body of knowledge that you personally find unpalatable WLU! Dickmojo (talk) 04:23, 1 February 2012 (UTC)

Pursuant to my point, the wording of that sentence ("there is no evidence blah blah blah") implies that research has been conducted and that the results of this research conclusively found that there was no evidence at all. Well, this is patently false, because the source itself says that 7 out of 9 studies reviewed found positive evidence to support the theory of enhanced electro-conductivity of meridians. Now it is a gross violation of NPOV to seek to cover that fact up, WLU, so I have restored it in the lede. If you want to delete it, then delete the whole sentence, and move it to the mechanism section.Dickmojo (talk) 06:37, 1 February 2012 (UTC)

7 out of 9 shoddy studies with poor methodologies. Would you accept a chemotherapy treatment, blood thinner or antibiotic with a similar evidence base? I wouldn't. Multiple reverts from multiple editors suggest nor would others. WLU (t) (c) Wikipedia's rules:^simple/_complex 16:40, 1 February 2012 (UTC)

WLU, you are mistaken. This is NOT research into the efficacy or safety of acupuncture as a treatment. In fact, this research isn't even medical research, it is scientific research into the phenomena of Qi and Meridians themselves. Now, if we are going to infer that scientific research has been completely unable to find any evidence of Qi or Meridians AT ALL, then this is clearly biased POV, and does NOT correlate with the evidence, which is suggestive of the existence of electro-conductive properties of Acupoints and meridians.Dickmojo (talk) 22:16, 9 February 2012 (UTC)

Poor comparisons- acupuncture does not carry nearly the same risk, nor does it claim the same effects. But that's irrelevant to the question of whether or not we can include carefully qualified statements about research from primary sources in a field of research that is not well-covered. To give an accurate picture of the current scientific understanding of acupuncture, I think we should include primary sources as long as proper context is given. To only include the conclusion of the only systematic review of the very few studies of this kind gives the illusion of certainty of lack of "existence" due to the lack of context.Herbxue (talk) 16:20, 2 February 2012 (UTC)

You are right. Intervention-related risk is irrelevant, but your opinion as to what you "think we should include" is equally irrelevant. The Ahn et al (2008) review INCLUDES the Lee et al (2003) paper among its references. You know what that means? It means that they've already looked at it - and lots of other papers - and conclude: "The studies were generally poor in quality and limited by small sample size and multiple confounders. Based on this review, the evidence does not conclusively support the claim that acupuncture points or meridians are electrically distinguishable." If you include the Lee et al paper, then you should include ALL the primary sources from Ahn et al, and then what's the point of qualified researchers doing reviews AT ALL? Unfortunately, Ahn et al have thrown a spanner in the works by saying that "the preliminary findings are suggestive". Acupuncture adherents will of course jump on this as "evidence" that there's something in it. But Ahn et al don't say of what the preliminary findings are "suggestive." We cannot, and should not, interpret what Ahn et al may have meant by that statement. It could have meant that they thought the preliminary findings are suggestive of bullsh*t. We don't know. Debate over. Go home. Famousdog (talk) 16:49, 2 February 2012 (UTC)

Ok, don't get too bent out of shape, my point again is not to prove existence of Qi, but to allow some primary sources into the possible mechanisms section.Herbxue (talk) 17:52, 2 February 2012 (UTC)

NONSENSE famousdog! The findings are clearly suggestive of the enhanced electro-conductive properties of meridians and acupuncture points, because 7 out 9 studies and 5 out of 9 studies showed us as such. Now, this is important evidence. Yes, the methodology may not be perfect, it never is in this field. BUT if we are going to be balanced, then we can NOT infer that exhaustive research has been done and absolutely no evidence of the existence of Qi or Meridians has been found. This is patently false, and you are seeking to deceive our readers. Research has been conducted and evidence HAS been found which suggests the electro-conductive properties of acupoints and meridians, therefore you CANNOT state that "no evidence of qi or meridians has been found". If you want to keep this sentence here, then you MUST include a qualifier that refers to the fifth source. I will edit the lede again, your threats to ban me for edit-warring are preposterous. We need balance in this article, and you guys certainly aren't going to provide it, so I must.Dickmojo (talk) 22:16, 9 February 2012 (UTC)

@DM, this sort of comment, that you plan to edit war your preferred version into the article despite warnings, is unwise. You need to discuss your proposals and establish consensus before introducing them to the article. If you revert again, or insert content as ludicrous as your last edit, this will end up at a noticeboard. You can use that information as you see fit. To everyone else, I have to second WLU here, that primary sources are not ideal to establish the efficacy of medical claims, or the existence of supernatural entities for which we have secondary sources to the contrary.   — Jess· Δ♥ 23:04, 9 February 2012 (UTC)

What "supernatural claims"?!? You're the one being ludicrous! These are NOT medical claims, as I pointed out to WLU, this is scientific research in the fields of biology and physics into the electro-conductive properties of meridians, and the research suggests that in fact there ARE electro-conductive properties of meridians. This assumption that Chinese Medicine is all about "hocus pocus" and "woo woo" is not helpful. In fact its xenophobic. The scientific discoveries of TCM are far removed from us in modern day times in both time and space. Obviously the language they used was far, far different from the language we use today. But their scientific discoveries ARE valuable, and we have to approach them in the sense of open-minded earnestness and curiosity, not outright skepticism and dismissal like you Jess, and WLU, and famousdog et al are wont to do. My last edit was not ludicrous, it was pointing out the manifest truth that you people are fanatics. Skepticism is your religion and Edzard Ernst is your messiah and you are NOT helping to improve the richness and diversity of the fabric of life in modern society. In fact you are working sinisterly to accomplish the opposite.Dickmojo (talk) 00:24, 10 February 2012 (UTC)

Pursuant to this point, I'm not just saying it to take a gratuitous swipe at you, I mean, hey, everyone's entitled to their religious beliefs (even if you can't even admit that's what they are), but its important because if you're going to say "PROPONENTS of acupuncture claim blah blah blah", then your identification of one side of the debate needs to be balanced with recognition of who the other side of the debate making counter claims are (i.e. zealous rational-sceptic extremist fanatics). Otherwise, you are violating NPOV.Dickmojo (talk) 00:42, 10 February 2012 (UTC)

If there is actually something to meridians, then evidence will accumulate supporting this point. To date that hasn't happened despite several decades of research (meanwhile, the dividends paid by research in other areas of biology and medicine need no explanation or pointing out). The difference between science and religion is that science changes with evidence, while religion adheres to an orthodoxy - such as refusing to acknowledge, even in principle, that qi, meridians and acupuncture points might not exist. The research doesn't suggest meridians have electrical properties - the research suggests that shoddy experiments suggest they might - and the shoddier the experiment, the easier it is to fool yourself. High quality methodology and controls make it easier to determine the objective reality of things. If meridians actually exists, the best tests will demonstrate this. If only poorly-controlled studies done by the credulous can find any evidence, then that's strongly suggestive of pathological science. If ancient Chinese doctors really discovered something and just explained it badly, then science will confirm their discoveries. This hasn't happened, despite having microscopes that can visualize individual atoms. To assume that the ancient Chinese were onto something without proof a) ignores how every other culture in the past was wrong about nearly everything, b) is quite racist (both pro-Chinese and anti-everyone else) and c) is not xenophobic - it's simply asking that the same standard of proof is used universally. If an Indian, American, British, Nigerian or Brazilian scientist makes an empirical claim about the body, they're expected to prove it, and that proof must be replicable. Why should it be different for Chinese scientists? Do the Chinese have some sort of different way of knowing? Are they magical? Is there some reason that the concepts expressed by the language of the Yellow Emperor's Inner Cannon can not be translated clearly into modern English or confirmed by objective tests? All skeptics ask for is proof. Real proof, replicable proof, proof that doesn't depend on who is providing it. Instead of proof however, we get claims like "ancient wisdom", "you're racist", "the richness and diversity of life". Basically accusations that we're mean because we're not willing to accept a double-standard and drop the bar for evidence claims for the Chinese. Sorry, I believe racism is not an appropriate way to conduct science. WLU (t) (c) Wikipedia's rules:^simple/_complex 10:22, 11 February 2012 (UTC)

Ok WLU, that whole ranting diatribe you wrote is rock-solid bonafide proof of why you should NOT be an editor on this page. The closed-minded, arrogoant, hate-filled attitude which you displayed in that paragraph above is indicative of the way you treat this entire topic, and it affects the POV of your editing very badly. Please get a life and stop attacking things about which COMPLETELY IGNORANT. I mean, how can "qi, meridians and acupuncture points" not exist? What a ridiculous POV you have! Can the concept of 'force' in physics "not exist"? Of course not! Then how can the concept of 'qi' in TCM not exist?: there are the same thing! And your example of the electron microscope is just so indicative of the reductionist attitude which hinders you from seeing the truth here. Meridians are not defined by STRUCTURE but by FUNCTION. Honestly, this is an elementary principle, you are just SOOOOO blithely ignorant it hurts. The Ancient Chinese Taoist Masters did not explain their findings "badly", they used an entirely different conceptual framework (which was, and IS, valid), and which you stubbornly refuse to even begin to countenance understanding. So if you're not interesting in understanding the conceptual framework upon which all of acupuncture and TCM hinges, LEAVE! You have no business editing an article on a subject you have no inclination to understand. This article is not titled "Proof for Acupuncture", and although there is ample proof for acupuncture, it is incidental to the purpose of this article. Scientific knowledge is not the only kind of knowledge. Lore, history, tradition and experience are also valid forms of knowledge. Under your pernicious influence all these four types of knowledge have been effectively disregarded, imbalancing the weighting of this article. Now it IS racist of you a) treat this topic as if its solely a scientific matter (its not, its a cultural, historical, traditional and empirical matter mainly of great importance to Chinese culture) , and b) completely dismiss all of the rigorous scientific evidence which strongly supports acupuncture that emanates from China. It is quite acceptable for a WP article to outline an alternative mode of philosophical understanding the body WITHOUT framing it in the context of extreme criticism when compared to the currently accepted scientific paradigm of knowledge. Go and look at the God article. Tell me, where is the vehement criticism against that philosophical concept? No where, yet here you feel the need to protect your extremely biased criticism of philosophical concepts in this article. Tell me, why WLU, if not racist prejudice against another culture's belief system? Science has got nothing to do with it. Its philosophy and belief and your criticism of it smacks of racism here in this article.Dickmojo (talk) 14:22, 14 February 2012 (UTC)

WLU's comments (whether correct or not) were about the content of this article. Your comments, Dick ... must ... not ... make ... a joke ... mojo (phew!) were about WLU. Stop making outrageous personal attacks and act with civility or you will be blocked. Comment on content, not on other contributors. Famousdog (talk) 15:18, 14 February 2012 (UTC)

Until there is a general consensus that there is good evidence acupuncture points and meridians exist, there shouldn't be any suggestion on the page that they have a real existence and we shouldn't be debating their existence. We can discuss the cultural, historical and philisophical background regarding these concepts - but immediately afterwards we must note that there is no empirical reason to believe they exist. Don't like it, go elsewehere. WLU (t) (c) Wikipedia's rules:^simple/_complex 18:59, 14 February 2012 (UTC)

Fine, but we don't need to say that there's evidence they exist. But we ALSO don't need to say that there's no evidence they exist. Such a statement is ludicrous. I had a look at the physics site and no where does it question the validity of the theoretical concept of "force". Therefore, we do not need to question the validity of the theoretical concept of "qi", (which is the same thing, just originating from a different culture and articulated in a different language), unless we intend to be racist. I certainly don't want to be racist, so why are you zealous skeptic extremists fanatics so intent on being racist?Dickmojo (talk) 23:43, 14 February 2012 (UTC)

"Force" can be empirically defined and demonstrated to work. Unlike qi. WLU (t) (c) Wikipedia's rules:^simple/_complex 23:50, 14 February 2012 (UTC)

Source

[1]

Review article?

This was recently used as a source to support a direct quote from the article. I'm wondering if this counts as a MEDRS compliant article, however, as it simply reads like a summary of primary studies and doesn't seem to draw any conclusions regarding either acupuncture, nor does it contain analysis of the study. Thoughts? N^oformation ^Talk 06:39, 16 January 2012 (UTC)

It is certainly not a systematic review, but rather a convenient collection of individual studies. Depends on what it is being used to support - most likely it is better to reference the individual study mentioned in the article. Nonetheless I would say the article is a reliable source, just can't be used to establish general efficacy claims.Herbxue (talk) 17:32, 16 January 2012 (UTC)

I wouldn't include it - seven articles, all published in China, unreplicated, using vague secondary measures of "improved immune function" is a rather meaningless addition. WLU (t) (c) Wikipedia's rules:^simple/_complex 18:45, 16 January 2012 (UTC)

I didn't think so. It was being directly quoted in this edit. Summarizing a list of primary sources seems equivalent to simply using primary sources as claims of efficacy. N^oformation ^Talk 20:19, 16 January 2012 (UTC)

"Vague secondary measure"?? leukocyte phagocytosis, interleukin-2 (IL-2) and natural killer (NK) cell activity, CD3+ and CD4+ T-lymphocyte subsets, white blood cell count etc are "vague"? "Secondary"? I'm afraid not WLU. And I'm sorry, but its racist to imply criticism of a study on the sole grounds that it originates from a certain country. I think this evidence ought to be included, its the latest research and readers have a right to know about it. NPOV would be seriously impaired if we omitted all mention of this evidence.Dickmojo (talk) 13:54, 1 February 2012 (UTC)

POV

The languaging of the intro has a clear bias against acupuncture. Whilst I'm no great fan of acupuncture, it should be judged in comparison to more conventional treatments for conditions it seeks to treat. The Cochrane Review alone is a stronger evidential basis than most conventional treatments have.

The POV languaging bias is of the form: 'Acupuncture doesn't work... except for maybe this'. Secondly, the intro is too long and too dense with scientific jargon. Most of this latter info is repeated later on in the Scientific Basis section and thus should be summarised in much simpler language. Mindjuicer (talk) 06:13, 3

Whether it works, and on what, is probably the most important thing to know about a treatment. Explaining that in the lede seems appropriate to me. --Anthonyhcole (talk) 08:05, 3 February 2012 (UTC)

I agree. It is a bit more complicated than that though. Whether it will work for you depends on what your problem is and what your expectations are (both in encouraging placebo and what you measure 'works' by).

For most problems that I suspect acupunture patients are seeking help for, placebos work typically 50% of the time according to (ridiculous 6 week do-you-feel-any-better-at-all) standards of testing. Often the traditional treatment barely outperforms that eg 55%. For potential patients, that difference is practically insignificant.

So 'effective' and 'works' mean radically different things to different people and thus these terms should be avoided. Efficteveness of placebo is largely underestimated and so that's tricky too.

Two other segments of the audience I'd consider:

Medical professionals - these are the people who need to know how reliable the research is and what it says. But they should be looking in the Scientific Basis section.

Curious people - that Cochrane showed a particular acupuncture treatment worked as well as effective drugs for nausea is quite interesting.

You didn't say anything about the bias.

What proportion of editors for this article are anti-acupuncture zealots who are determined to keep the article negative? I don't want to waste my time here. Mindjuicer (talk) 10:01, 3 February 2012 (UTC)

Good point. And infact, I think we need to include this specification in the lede for balance. I.e, if we're going to say "proponents of acupuncture say blah blah blah", then we also need to specify that the people who disagree with this are in fact fanatic, zealous, Edzard-Ernst worshiping sceptic extremists. I shall amend the lede now, cheersDickmojo (talk) 22:00, 9 February 2012 (UTC)

"Anyone who doesn't agree with me is a zealot!" - "You're all in the pay of Big Pharma" - "You're all biased (but I'm a paragon of objectivity)!" - "Science isn't science it's scientism or pseudo-skepticism (or some other stupid neologism)!"

(ahem) Now that's out of my system, the placebo effect is effective. That is not an argument for acupuncure. It is an argument against acupuncure. Famousdog (talk) 10:18, 3 February 2012 (UTC)

Anti-acupuncture? There have been some in the past. I got blocked for abusing a couple once. But they don't last long; about as long as the pro-acupuncture editors. Of the two I'm referring to, one has been informally hounded off the project and the other has been officially permanently banned.

Bias? I don't see bias there. Acupuncture does work for some cases of pain and nausea, but there's no evidence for anything else.

Too long and dense? I agree. I think

"Systemic reviews have found conflicting results regarding the prevention of postoperative nausea and vomiting^{[14][15] though a 2009 Cochrane review concluded stimulation of the P6 acupuncture point was as effective as antiemetic medications.[15] Acupuncture also appears to have a small effect in the short-term management of some types of pain[10][16][17] though a 2011 review of review articles concluded that acupuncture was of doubtful efficacy in treating pain other than neck pain.[13]"}

is too much detail for the lede, and would be interested to hear whether you or others think it should be excised. --Anthonyhcole (talk) 10:43, 3 February 2012 (UTC)

I'm thinking rewriting that whole paragraph is in order. The NHS statement "'reasonably good evidence that acupuncture is an effective treatment" for nausea, vomiting, osteoarthritis of the knee and several types of pain' is clear, NPOV and concise. I'd definitely move the last sentence of the last paragraph of the intro to the Scientific Basis section. The remainder needs shortening.

But first I'd be looking for consensus on what _should_ be in the intro and what form of languaging is appropriate.

How do you cope with FamousDog? Mindjuicer (talk) 11:33, 3 February 2012 (UTC)

Other editors don't "cope" with me. They attempt to argue their case and provide reliable sources for their edits rather than casting aspertions and trying to argue that perfectly good sources are somehow dubious. You say above that there is bias int he lead along the lines of: 'Acupuncture doesn't work... except for maybe this'. That's not bias. Considering the ridiculous claims that have been made for thousands of years regarding its efficacy for all sorts of maladies, that form of wording is a useful corrective of the acupuncture community's long-standing (and, it now turns out, empty) claims. You say that "the NHS statement ... is clear, NPOV and concise." It is certainly clear and concise, but that quote misrepresents the source and introduces a bias. Shortly after that statement in the NHS summary there is the following disclaimer: "... however, because of disagreements over the way acupuncture trials should be carried out and over what their results mean, this evidence does not allow us to draw definite conclusions." Who's introducing a POV now, then? Famousdog (talk) 12:16, 3 February 2012 (UTC)

I'm quite happy with that paragraph, apart from the excision I suggested. And I wouldn't support using that NHS statement. Your quote is followed by

However, because of disagreements over the way acupuncture trials should be carried out and over what their results mean, this evidence does not allow us to draw definite conclusions.

Some scientists believe that good evidence exists only for nausea and vomiting after an operation. Others think that there is currently not enough evidence to show that acupuncture works for any condition.

The existing wording and sourcing is fine by me. --Anthonyhcole (talk) 12:52, 3 February 2012 (UTC)

This is too wordy for an intro and probably no rewording would interest all readers.

POV is, of course, determined by the overall balance of the intro.

Even Famousdog seems to agree that the first part of the statement could be incorporated provided that there is some balance to it. My question is: what else needs to be in that paragraph? Mindjuicer (talk) 14:50, 3 February 2012 (UTC)

Personally, as I said, I'm happy with the lead, but I'd like to excise that text I mentioned earlier, unless someone has a problem with that. --Anthonyhcole (talk) 15:49, 3 February 2012 (UTC)

Famousdog, have you seen WP:PHARMANOIA? Might intrigue you.

Saying something "works" but only as well as placebo (and the placebo effect isn't unitary, surgery > needles > 2 pills > 1 pill) is a less honest way of saying that it can be explained by as a placebo - which the lead does. Normally I don't think we would compare one treatment to another in the treatment's page, though perhaps in the disease it is treating we might mention comparative effectiveness. The real issue isn't if it "works" or not, the real controversy is if it works beyond mere placebo. Right now it doesn't "work" for anything but pain and nausea, and they're having a hard time telling if this is due to placebo or something specific to the intervention.

Similarly, saying something has equivocal results for pain and nausea, then listing the types of pain and nausea it may work for, isn't good - for fairness we'd also have to list all types of pain and nausea for which it didn't work. Better to leave it as simply "results equivocal" which can incorporate those conditions it has evidence it does "work" for, and those it doesn't.

Nothing the NHS' endorsement of acupuncture doesn't seem right in the lead, particularly when it's accompanied by a "this endorsement has been criticized" citation and several other orgs that have had similar endorsements. Again, if we note what it's "effective" for, we should also be noting what it's not effective for, unless it's clearly and unambiguously a slam-dunk for a specific condition - which it's not.

I've shortened the lead, there were too many specifics and qualifications. WLU (t) (c) Wikipedia's rules:^simple/_complex 18:17, 3 February 2012 (UTC)

The mistake you are making is thinking that "sham" acupuncture = placebo. It does not. "Sham" acupuncture is in reality precisely similar to certain techniques from Japanese schools of acupuncture hundreds of years old, that are still used to today by huge numbers of alternative acupuncture therapists, and which are noted for their subtle and powerful effects. "Sham" acupuncture is not an inert treatment, like a true placebo is supposed to be, and you look at the data: while the difference between "real" acupuncture and "sham" acupuncture is small, sometimes even clinically insignificant, the difference between "sham" acupuncture and no treatment is large. In fact, the data shows a significant difference between the effect of "sham" acupuncture and fake steroid injections, so we can see that so-called "sham" acupuncture is actually not analogous to placebo at all, therefore it is inappropriate to say that "acupuncture is a placebo" or "acupuncture only works through the placebo effect" like you are (shamefully persisting) in doing, WLU.Dickmojo (talk) 22:51, 9 February 2012 (UTC)

For example, look at this study of rats: it clearly shows a powerful effect from acupuncture above and beyond the placebo effect, objectively proven with chemical analysis: http://nccam.nih.gov/research/results/spotlight/010112.htm ACUPUNCTURE IS NOT PLACEBO Dickmojo (talk) 22:56, 9 February 2012 (UTC)

Feel free to start the page acupuncture in small groups of rats, but please restrict citations to secondary sources. "Sham" procedures incorporate a wide variety of techniques - altering the needling location, using nonpenetrating needles, most recently using toothpicks instead of needles [2], and in some studies, controlling for practitioner confidence and empathy. If "sham" and "real" acupuncture have identical results, doesn't that suggest to you that all the elaborate ceremony of interview, "diagnosis" and selection of points is worthless and education should instead be a brief study of how to maintain sterile procedures and avoid hitting nerves, blood vessels and organs? Of course, for a lot of practitioners that would be like a priest or someone with a PhD in theology becoming an atheist, it would be incredibly hard to admit they wasted so much of their lives on what is really the equivalent of memorizing the chants used by witchdoctors. It would take a lot of courage to abandon the pretense of "ancient Chinese wisdom" and stick with simple safety precautions instead. WLU (t) (c) Wikipedia's rules:^simple/_complex 09:59, 11 February 2012 (UTC)

In real life, you want to maximise the placebo effect as it is easily the main therapeutic mechanism for most ailments, even with traditional medicine. Only in trials do you want to minimise it.

I'm glad you shortened the intro but it's still about twice as long as it should be. I note that you removed mention of the Cochrane review and effectively stated that the successful treatment of nausea it concludes is equivocal??? Mindjuicer (talk) 13:57, 13 February 2012 (UTC)

Doctors quite conciously use the placebo effect + real effective medicine to treat patients. Suggesting that the placebo effect + any old nonsense is "good enough" and we should make use of it, would constitute a disturbing breach of patient-practitioner trust. The same applies to any treatment that relies solely on the placebo effect, such as homeopathy and the vast majority of alternative medicine. Why not give up acupuncture completely an concentrate on teaching doctors how to maximise the placebo effect in their daily practice? That would be a much better use of time and resources. Famousdog (talk) 15:56, 13 February 2012 (UTC)

Unfortunately for you, Cochrane says acupuncture is effective for nausea. Mindjuicer (talk) 16:30, 13 February 2012 (UTC)

Unfortunately for me? You imply by that statement that I have a problem with listing things on this page for which there is good evidence that acupuncture can help. I most certainly do not. I, like other editors you would smear as "skeptics", just want to see the evidence behind acupuncture's claims. It seems to me that for everything except nausea, that evidence base is weak to non-existent. This is not unfortunate for me in the slightest - it is, however, unfortunate for acupuncture practitioners and the people that trust them. Famousdog (talk) 11:57, 14 February 2012 (UTC)

WLU says "If "sham" and "real" acupuncture have identical results, doesn't that suggest to you that all the elaborate ceremony of interview, "diagnosis" and selection of points is worthless and education should instead be a brief study of how to maintain sterile procedures and avoid hitting nerves, blood vessels and organs?". No, WLU, in fact not. You are engaging in pure speculation here, pure undiluted speculation. And while you're entitled to your speculations, you cannot pretend even for one instance that they are anything BUT pure, fanciful, undiluted speculations. The truth is that most "sham" acupuncture controls that are used in testing are actually valid and effective forms of treatment. But of course there are different standards used, which actually makes most of the research on acupuncture that's been done practically useless and unreliable, especially so since the critical aspect in the efficacy of acupuncture is the skill of the practitioner. This is noted in the classic texts, going all the way back to the Huang di nei jing. The skill of the practitioner's manipulations and needle techniques are critical, yet none of the studies take this variable into account, therefore they are essentially worthless. Indeed, the only really valuable research out there are the Chinese studies (because of the expert skill of Chinese practitioners in general in this regard vis-a-vie Western practitioners), and you'll note that they are all universally positive on the efficacy of acupuncture. But for a zealous rational-skeptic extremist fanatic to accept that would be like a Spanish Inquistor suddenly deciding to stop persecuting witches for their "heresy".Dickmojo (talk) 14:35, 14 February 2012 (UTC)

Firstly, WLU's comments ("for a lot of practitioners that would be like a priest or someone with a PhD in theology becoming an atheist") were about acupuncture practitioners generally (and he has a point, namely: undisprovable = pseudoscience). What you just said ("zealous rational-skeptic extremist fanatic like you...") was a personal attack. Do not cross this line again please. Famousdog (talk) 15:18, 14 February 2012 (UTC)

There, fixed. No can we please get back to my points about the article?Dickmojo (talk) 23:51, 14 February 2012 (UTC)