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Korean invented acupuncture

Chinese steal everything. Acupuncture was actually invented by Korean during Gojoseon era. Ancient Chinese doctors traveled to Korea and learn from Korean master. — Preceding unsigned comment added by 99.225.190.42 (talk) 06:20, 27 June 2013 (UTC)

Synthesis violation in the lead

Other reviews have concluded that positive results reported for acupuncture are too small to be of clinical relevance and may be the result of inadequate experimental blinding, or can be explained by placebo effects and publication bias.

A 2009 usurped systematic review is being used (Madsen, 2009) to state the 2012 reviews effects are "too small to be of clinical relevance and may be the result of experimental blinding". The claim that acupuncture can be explained by the placebo effect (Singh, Ernst, 2008), (Ernst, 2006) is outdated research and the publication bias has nothing to do with the new reviews whatsoever. It is dated as well. For these reasons, this sentence should be removed from the lead. DVMt (talk) 03:03, 13 March 2013 (UTC)

Agree. --Mallexikon (talk) 06:37, 13 March 2013 (UTC)

Done. Good work! Ok, part 2:

Best to remove the Singh, Ernst reference from the page. This has been rejected by multiple authors at an imbalanced piece. Granted, truth is mixed in the work such as securing methodology are primary and tobacco cessation but the acupuncture section is not accurate. The reductionist view of CAM equates and conflates multiple procedures of CAM with acupuncture which are not related. Also, in violation of Misplaced Pages editorial guidelines, the work uses 25% of its own work as a primary source and not a secondary source.TriumvirateProtean (talk) 00:14, 23 May 2013 (UTC)

Physical correlates of acupoints

This interesting study contributed by Acuhealth unfortunately does not meet the requirements of a reliable source for medical articles. The sources you deleted, on the other hand, did; they're also not outdated. Good faith edit, but I still have to revert it. Cheers, --Mallexikon (talk) 06:11, 21 May 2013 (UTC)

The aforementioned research by members at Department of Biological Science, Sungkyunkwan University, Department of Chemistry and Nano Science, Ewha Womans University and the Graduate Program for Health Science and Technology, Sungkyunkwan University, was rejected as unreliable. However, the research is accepted, peer reviewed material and shows distinct characteristics of both acupuncture points and the meridians they are on.Acuhealth (talk) 14:35, 21 May 2013 (UTC)

You may find the research from the Massachusetts Institute of Technology more acceptable. Researchers from MIT and the University of Michigan utilized MRI research to demonstrate that autonomic nervous system (ANS) responses to acupuncture emanate from “distinct subregions” of “brain circuitry.” True acupuncture activated the secondary somatosensory cortex (S2), insula and the mid-cingulate cortex. The heart rate (HR) deceleration and skin conductance response (SCR) “magnitude of response was greater following real acupuncture” than with sham acupuncture. This research may allow for the acceptance of the edit. The source:Acuhealth (talk) 14:35, 21 May 2013 (UTC)

In reality, there are numerous studies from the most prestigious universities worldwide showing that true acupuncture points, when needled, activate and deactivate distinct areas of the brain and endocrine system whereas sham acupuncture does not. At this point, that is not considered a controversial topic in that it has been proven repeatedly in controlled, randomized trials of sufficient size and variable controls. Acuhealth (talk) 14:34, 21 May 2013 (UTC)

This next study is quite fascinating: Here, we find that researchers have found "electroencephalographic similarities of acupressure induced sedation and general anesthesia as assessed by bispectral index and spectral edge frequency." In this instance, needles were not required at the acupoints but rather pressure.Acuhealth (talk) 14:34, 21 May 2013 (UTC)

Dr. Cho's book, Neuro-Acupuncture written by Cho, Wong, Falton, shows not only does acupuncture SJ5 exist but that it functionally acts to stimulate the auditory cortex of the brain. As denoted by historical Chinese medicine texts, the function of this acupoint is to benefit hearing. Dr. Cho is a professor of Radiological Sciences and Director of functional Brain Imaging Laboratory for Acupuncture Research (BILAR). University of California, Irvine, California. From 979-1985, he was Professor of Radiology (Physics) and Co-director of Imaging Research Center, Columbia University, New York, New York. Dr. Cho is a member of the US National Academy of Sciences and has won numerous awards including the Distinguished Scientist Award: International Workshop on Physics and Engineering in Medical Imaging; Organizing Committee of International Workshop on Physics and Engineering in Medical Imaging,March 15-18, 1982, Asilomar, California U.S.A. To read his book on Neuro-Acupuncture: Acuhealth (talk) 14:34, 21 May 2013 (UTC)

You note that one reference is accepted, Trick or Treatment. This piece is largely a specific attack on homeopathy and chiropractic care. It is highly politically charged. One author of the book, for example, was dismissed from Exeter University over the Smallwood incident. It seems that the author took exception to Prince Charles' private secretary of the cost-effectiveness of CAM therapies. Politically charged books such as this are not exactly purely scientific investigations, the Smallwood incident is no exception. I suggest that this reference be struck. Granted the lawsuit from the British Chiropractic Association against the other author for material in this book, Singh, was dropped. Nonetheless, the controversy of this book surrounded other elements such as the dedication of the book to the Prince of Wales. Perhaps this was a tongue in cheek retort given the politically charged incident with his personal secretary. Acuhealth (talk) 14:51, 21 May 2013 (UTC)

The next reference that you note is acceptable is most clearly not and is entirely misleading. It is a support piece of acupuncture therapy with two negative quotes by Felix Mann in it. This is not peer reviewed literature and has no place as a reference. The article supports the efficacy of acupuncture and to cite it as an example of supporting the non-existience of acupuncture points is misleading. It is written by a singular author and is not part of a randomized, controlled trial or basic research. It is a nice historical piece, however, and nice reading but is not supportive of the claim for which it is used to cite. Rather, it supports the contrary. Moving to the Felix Mann quotes contained within the article cited, Mann wrote, "The meridians of acupuncture are no more real than the meridians of geography. If someone were to get a spade and tried to dig up the Greenwich meridian, he might end up in a lunatic asylum. Perhaps the same fate should await those doctors who believe in meridians.... The traditional acupuncture points are no more real than the black spots a drunkard sees in front of his eyes...." This is hardly a scientific investigation or a conclusion based on research. I suggest this reference be struck immediately. This is a charged, opinion by Felix Mann and is taken out of context from Bauer's article. Highly inappropriate and goes to undermining the integrity of Misplaced Pages.Acuhealth (talk) 15:07, 21 May 2013 (UTC)

The final reference given to support the opinion that no scientific correlates exist regarding the existence of acupuncture meridians and acupuncture points actually goes so far as to suggest that studies showing the existence of acupuncture meridians are suggestive of the fact that they do exist. The sole purpose of the study was to investigate whether or not there are distinguishable electrical properties of acupuncture points and meridians. This does not preclude the research on oxygen levels showing the existence of both acupuncture points and meridians, nor does this negate Cho's MRI investigations showing the existence of acupuncture points. Further, the cited work used to support the notion that meridians do not exist goes so far as to say that future research may be able to detect the meridians with more sensitive equipment. The conclusion from the study reads, "While inadequate, the evidence is more supportive of the claim that acupuncture meridians are electrically distinct. The meridian studies were generally of higher quality and were more inclined to consider polarization effects than the point studies. While the results are suggestive, additional studies should be performed to determine whether the results are replicable. Preliminary interpretation of the data suggests that deeper, subcutaneous tissue layers may be an important component in the increased capacitance and decreased resistance reported at acupuncture meridians. If so, future studies may consider using larger surface electrodes (1 cm) separated by sufficient distance to minimize the contribution of superficial layers to the impedance or admittance values. Alternatively, they may use invasive electrodes. With the development of sophisticated impedance analyzers, frequency-related changes in impedance are relatively easy to perform and make this area of research ripe for further exploration."Acuhealth (talk) 15:31, 21 May 2013 (UTC)

This revision was undone by yet another user and referred to an explanation in talk. However, this user made no explanation in response to my response to the first undo. Citing non-MEDRS, the user did an undo. However, I demonstrated that the non-MEDRS was the material stating that there were no scientific correlates for acupuncture points and meridians. As shown above, there are a plethora of peer reviewed medical studies showing that the acupuncture points exist and function and the meridians. The user needs to respond to this research before performing and undo. Let the science speak for itself. The current version showing a scientific correlate cites studies from MIT, University of Michigan and more. The original statement removed was inaccurate and cited opinion papers and unsupportive documentation. Acuhealth (talk) 17:24, 21 May 2013 (UTC)

There is now a conflict between the lead - "Scientific investigation has found a measurable correlate for acupuncture points" and the section on Physical correlates of ... points .. meridians - "no research has established any consistent anatomical structure or function for either acupuncture points or meridians". The research cited in the lead would be acceptable in the Physical correlates section, but is probably too new (mostly primary sources) for the lead. There is also mounting primary research on correlates for meridians eg Zhang WB et al: Understanding propagated sensation along meridians by volume transmission in peripheral tissue, Chin J Integr Med. 2013; 19(5):330-9 and Silberstein M: Do acupuncture meridians exist? Correlation with referred itch (mitempfindung) stimulus and referral points, Acupunct Med. 2012; 30:17-20. These are primary sources too, but probably merit inclusion in the Physical correlates section. This article needs to reflect ongoing research in this area. What do other editors think? — Preceding unsigned comment added by Tzores (talk • contribs) 23:27, 21 May 2013 (UTC)

Acuhealth, you presented 13 (!) sources for your claim - and 12 of those do not support the claim about a physical correlate of acupoints at all! The one source that does still doesn't qualify as MEDRS. And this article of course has to reflect ongoing research, but only within the framework of what is verifiable - those primary sources are not reliable enough. That's why Misplaced Pages has guidelines about MEDRS. Cheers, --Mallexikon (talk) 04:45, 22 May 2013 (UTC)

How does the research from Sungkyunkwan University/Ewha University not meet modern scientific standards? These are perhaps the two most prestigious universities in Korea. It clearly shows partial oxygen pressure is higher at acupuncture points and through the meridians. Samsung Group owns Sungkyunkwan and the nanotechnology group is top notch and built with Samsung financial support. I need a reason why you feel that this is not some of the best research ever conducted. It is a scientifically validated, repeatable phenomenon. What aspect of the amperometric oxygen microsensor detections of partial oxygen pressure do you find unsubstantial or putative? How is this unverifiable, it hails from a top research institution worldwide. Ewha gave Korea its first female doctor, lawyer, court justice and prime minister. Sungkyunkwan has a dual degree program with Ohio State University and a joint program with MIT. Further, another study citing adenosine related to acupuncture point stimulation is widely accepted along with other research submitted showing endocrine and brain center correlates. I am now suspicious that this is an attack on scientific data in an effort to mollify the research on acupuncture. Acuhealth (talk) 04:53, 22 May 2013 (UTC)

I'm not saying this study doesn't meet modern scientific standards... I'm only saying it's not the kind of source that the MEDRS guidelines require (cause it's a primary source): we need secondary or tertiary sources here. Please read WP:MEDRS. --Mallexikon (talk) 07:03, 22 May 2013 (UTC)

If you want to add these sources, let's add them one at a time. To start, propose an edit which uses the Hong et al source and quote directly from the source to support your edit. TippyGoomba (talk) 05:15, 22 May 2013 (UTC)

Oh, reading above, it appears that the particular source I gave as an example is the poorest. Let's start with the other 12. Please pick one and let's get started. TippyGoomba (talk) 05:17, 22 May 2013 (UTC)

Why is the Hong et al considered the poorest? It is clear, hard, objective data. Acuhealth (talk) 05:20, 22 May 2013 (UTC)

(Please indent your posts using colons.) Apparently the journal sucks. Why don't we focus on your other sources first and we can talk about the journal when the rest is resolved. Would you like to propose an edit? TippyGoomba (talk) 05:23, 22 May 2013 (UTC)

Actually, I don't think the journal sucks. But the article in question is only a primary source. Cheers, --Mallexikon (talk) 07:03, 22 May 2013 (UTC)

Here are three important works:

Minagawa, Munenori, Yasuzo Kurono, Tatsuyo Ishigami, Atsushi Yamada, Toshinori Kakamu, Ryoichi Akai, and Junichiro Hayano. "Site-specific organ-selective effect of epifascial acupuncture on cardiac and gastric autonomic functions." Autonomic Neuroscience (2013).

A PET-CT study on specificity of acupoints through acupuncture treatment on migraine patients. Jie Yang1, Fang Zeng1, Yue Feng1,Li Fang1, Wei Qin2, Xuguang Liu1, Wenzhong Song3, Hongjun Xie3 , Ji Chen1, Fanrong Liang1.

Point specificity in acupuncture. Chinese Medicine 2012, 7:4 doi:10.1186/1749-8546-7-4. Emma M Choi, Fang Jiang, John C Longhurst. Susan Samueli Center for Integrative Medicine, Department of Medicine, School of Medicine, University of California, Irvine CA.

The first study shows specific points correlate to specific internal organ responses. The second demonstrates PET-CT verification that the point exists and exerts a specific brain response to eliminate migraines. The third demonstrates point specificity.Acuhealth (talk) 05:27, 22 May 2013 (UTC)

The assertion that the "journal sucks" does not seem like a scientific allegation that the research from a top university is not valid.Acuhealth (talk) 05:27, 22 May 2013 (UTC)

Hemodynamic changes associated with acupuncture are also scientific correlates as found in: Arai, Hiroyuki, Yoshifumi Saijo, Tomoyuki Yambe, and Nobuo Yaegashi. "RADIAL ARTERY HEMODYNAMIC CHANGES RELATED TO ACUPUNCTURE."Acuhealth (talk) 05:30, 22 May 2013 (UTC)

Let's start with just one to keep things simple. Suggest and edit and quote from the source in support of your edit. TippyGoomba (talk) 05:32, 22 May 2013 (UTC)

And please keep in mind that WP:MEDRS requires secondary or tertiary sources... --Mallexikon (talk) 07:03, 22 May 2013 (UTC)

Physical correlates of acupoints, Part Two

Naturally, after an exhaustive explanation of the garbage literature that has been allowed to stand and the redaction of qualified peer reviewed studies I am convinced that this is an attempt to wear credible resources down until the article reverts. Here is but one of many quotes ready to go:

Researchers at the University of California School of Medicine (Irvine, California) note, “Recent evidence shows that stimulation of different points on the body causes distinct responses in hemodynamic, fMRI and central neural electrophysiological responses.” The investigators reviewed MRI results and noted that “stimulation of different sets of acupoints leads to disease-specific neuronal responses, even when acupoints are located within the same spinal segment.”' Point specificity in acupuncture.

Acuhealth (talk) 05:39, 22 May 2013 (UTC)

That's the kind of suggestion I was looking for! I cleaned it up a bit for readability, i hope you don't mind. TippyGoomba (talk) 05:44, 22 May 2013 (UTC)

I see you undid the insertion, but how can you insert that trash literature and out of context work? We are talking about citing a resource for authors that were thrown out of Exeter University. I covered it in detail in talk. No place in science.Acuhealth (talk) 05:53, 22 May 2013 (UTC)

Don't forget to indent. No one has comment on your suggestion yet. See WP:CONSENSUS. TippyGoomba (talk) 06:05, 22 May 2013 (UTC)

Acuhealth, please answer some questions. What do you think of the purpose of this or any other article at Misplaced Pages? Do you think it is supposed to (according to our policies) only cover scientific research? Do you think it is supposed to only cover controversies? Do you think it is only supposed to cover history? Seriously, do you know anything about Misplaced Pages's content policies? -- Brangifer (talk) 06:23, 22 May 2013 (UTC)

The purpose of the acupuncture article is to cover acupuncture objectively. It most certainly includes opinion and, in this case, opinion trumps scientific data. Going to consensus building as a wikipedia policy, rewording to make an implied consensus taking into account variances is a standard wikipedia policy. I see the reversion meaning that the change was not acceptable to someone. The article should reflect objective findings and not present opinion as truth. It could be stated, "In my opinion, there is no correlate...." However, this is not stated and the new research is rejected. Please weigh in on the presented research demonstrating biomedical correlates for acupuncture points including MRI brain state changes, hemodynamics, oxygen pressure differentials and endocrine point specificity. Please read the above quotes and make your comment on whether or not the biomedical correlate issue is valid based on the objective evidence and presented data.Acuhealth (talk) 06:31, 22 May 2013 (UTC)

I obviously have a reason for asking. Keep in mind that objectivity is not a specific goal for ALL content. Some content documents the opinions of believers and skeptics, which is obviously subjective. NPOV requires that opposing POV be presented in articles, especially when there is controversy, and the removal of such content violates NPOV and is seen as whitewashing, which is not allowed. The controversy must be visible, not hidden, and you are well aware that acupuncture is controversial. In China it is even being used less and less as modern medicine is seen as more effective, but it has a long tradition there and still exists side by side with modern medicine. BTW, what is your exact position(s) at Five Branches University and Healthcare Medicine Institute? -- Brangifer (talk) 07:03, 22 May 2013 (UTC)

Please weigh in on the aforementioned quote, Researchers at the University of California School of Medicine (Irvine, California) note, “Recent evidence shows that stimulation of different points on the body causes distinct responses in hemodynamic, fMRI and central neural electrophysiological responses.” The investigators reviewed MRI results and noted that “stimulation of different sets of acupoints leads to disease-specific neuronal responses, even when acupoints are located within the same spinal segment.” Point specificity in acupuncture. Let's go with this and build consensus, I invite input on your view of the scientific validity, Acuhealth (talk) 06:43, 22 May 2013 (UTC)

"Stimulation of different sets of acupoints leads to disease-specific neuronal responses, even when acupoints are located within the same spinal segment”... I'm not even quite sure what this is supposed to mean... What statement do you want to use this as a source for, then? --Mallexikon (talk) 06:52, 22 May 2013 (UTC)

Thank you for asking. This quote is in response to a request for a quote on why there is a biomedical correlate for the existence of an acupuncture point. You had rejected the oxygen sensor study from two of the most prestigious universities in Korea. This study is from the USA. I thought that might avoid ethnocentric bias but including a different country of origin. In this quote, we see that specific acupuncture points are verifiable for specific biological effective actions. I find it more than wholly appropriate to delete the assertion that there is "no correlate" for acupuncture points.TriumvirateProtean (talk) 06:57, 22 May 2013 (UTC)

That is a typical finding of research that is extremely generic and tentative in nature. The quoted text has nothing to say about whether a particular person might benefit from paying money to someone who says they practise acupuncture, nor does it throw any light on whether acupuncture has ever been helpful for anyone. The proposed text might as well be "obviously the body will give various responses when needles are stuck in it, and we have measured some of those responses, but have no idea whether they mean anything". Johnuniq (talk) 07:05, 22 May 2013 (UTC)

The purpose of the quote was not to suggest medical benefits although there are numerous studies on that topic. Rather, this was to verify that acupuncture points exert specific biological responses as opposed to non-acupuncture points. The quote is specific to the edit in questions wherein I suggest removing the line "Scientific investigation has not found any histological or physiological correlates for traditional Chinese concepts such as qi, meridians and acupuncture points," because at least two of the supportive references are poor and the third is irrelevant (see earlier talk) and further, that biomedical correlates have been established. Simply, acupuncture points have specific effects on the human body hemodynamically and neurologically and that these effects are not caused by non-acupuncture points.TriumvirateProtean (talk) 07:10, 22 May 2013 (UTC)

Per MEDRS, we don't normally report on preliminary research that isn't confirmed by independent researchers and then as part of larger reviews. This type of thing takes years. These results you cite are highly speculative conclusions. It's sad to see this happen. Roughly speaking, every spot in the body has a corresponding "spot" in the brain. (Yes, that's very simplistically put!) There is nothing new about that, therefore affecting a spot on the skin is going to trigger some sort of response in a specific region of the brain. That proves nothing regarding acupuncture or potential effects on health. We need MUCH better research to conclude such things, but believers who perform this type of research immediately draw such unwarranted conclusions, which is one of the reasons that Chinese (and now Korean) research of this type is highly suspect and we'd like to see better research done, preferably by nonbelievers. If there really is something, it will show, regardless of the belief structure of the scientists involved. -- Brangifer (talk) 07:14, 22 May 2013 (UTC)

In response to "why anybody should pay for it", although I was not asserting specific medical benefits, I will list one very recent study showing acupuncture "was effective in lowering baseline BG (blood glucose) and modulating the change in BG."A relatively minor study, but it is very recent and somewhat interesting. Naturally, there are better studies than this with more substantive medical findings. Nonetheless, it shows a biomedical correlate to electroacupuncture and blood glucose changes so it is somewhat relevant to the discussion as to whether or not it is valid to assert there is no correlate.TriumvirateProtean (talk) 07:17, 22 May 2013 (UTC)

HRV is heart rate variability and acupuncture has been shown to improve HRV, an important measure of cardiovascular health. “HRV changes significantly during auricular acupuncture…” and “HRV total increases during auricular acupuncture….” come from one study. Another study from International Society for Autonomic Neuroscience notes that acupuncture “causes the modulation of cardiac autonomic function.” You mentioned non-believers, the International Society for Autonomic Neuroscience is rather staid if not stoic. They don’t need to believe, they need proof of medical effectiveness and found it. I suppose no one will like this either and you'll stick with the assertion that there is no correlate. There are many.TriumvirateProtean (talk) 07:24, 22 May 2013 (UTC)

I invite comment on the HRV quotes. Clearly, a correlate between biomedical findings and acupuncture point stimulation. Further, the sham acupuncture points in placebo controlled, randomized studies did not affect HRV whereas verum acupuncture does affect HRV. If you find this interesting and helpful in clarifying the correlate issue in question, please note. Medical fact is stranger than fiction.TriumvirateProtean (talk) 07:40, 22 May 2013 (UTC)

Specific acupuncture points increase antioxidant activity and decreases oxidative stress according to new research. TriumvirateProtean (talk) 12:57, 22 May 2013 (UTC)

A basic tenet of MEDRS for Misplaced Pages is to "respect secondary sources." At this point, I have given several sources from several of the most prestigious universities in the world. The current quote stating there is no correlate in biomedicine gives three non-MEDRS sources as explained in Talk. I suggest an immediate redaction of the "no correlate" statement as it is inaccurate and does not reflect MEDRS. TriumvirateProtean (talk) 13:03, 22 May 2013 (UTC)

To the effectiveness question by one reviewer, ““auricular acupuncture and intranasal midazolam were similarly effective for the treatment of dental anxiety,” as published in the prestigious Anesthesia & Analgesia from MDs from Hannover Medical School, Germany.TriumvirateProtean (talk) 13:09, 22 May 2013 (UTC)

Dr. Guidice, MD notes in the New England Journal of Medicine that acupuncture is effective for the treatment of endometriosis. TriumvirateProtean (talk) 13:12, 22 May 2013 (UTC)

Are you suggesting an edit? If so can you concisely restate it along with source(s) you wish to use? TippyGoomba (talk) 15:17, 22 May 2013 (UTC)

Yes, I am suggesting that the line in paragraph one stating, "Scientific investigation has not found any histological or physiological correlates for traditional Chinese concepts such as qi, meridians and acupuncture points" be redacted and supplanted with "Scientific investigation has found biomedical correlates for acupuncture points." The research was detailed in this talk section, parts 1 and 2. The Sungkyunkwan University (owned by Samsung Group) research cited oxygen pressure levels higher at acupuncture points and showed the meridians. The University of California report detailed hemodynamic and MRI findings on specific physical correlates for acupuncture points and specific biomedical actions for each point. The remarkable findings of HRV correlates for acupuncture point stimulation vs. placebo controls and sham acupuncture shows that acupuncture increases HRV and therefore benefits cardiovascular health. The International Society for Autonomic Neuroscience concurs stating, acupuncture “causes the modulation of cardiac autonomic function.” These are a few examples of supportive material for the edit. I also detailed the three citations for the existing, erroneous assertion that requires redaction. One citation is a discredited book and is an opinion piece, one is completely out of context and includes expletives in an unscientific manner and the third seems like valid research but only goes to the argument of the electroconductivity model of acupuncture points. This is completely detailed in Talk.TriumvirateProtean (talk) 15:56, 22 May 2013 (UTC)

So there appear to be four sources:

• Hong et al, 2012 - this is a primary source of a single acupuncture point measuring a single biomarker on a small number of subjects. It does not validate that all acupuncture points exist, that they are based on changes in skin surface oxygen level or that these changes are related to any of the health outcomes for acupuncture. I would not support citing this based on WP:MEDRS emphasis on secondary sources.
• Choi et al, 2012 - this is a recent secondary source, and could be integrated. I don't think it's definitive, and I'll definitely need to read it in detail to comment.
• Gao et al, 2012 - this is a primary source studying anaesthetized rats, not people. It shouldn't be cited.
• Kurono et al., 2011 - this is a primary study in 11 subjects.

Only Choi et al 2012 seems to be worth even discussing. Have I missed any sources? May I suggest starting a new section specifically for Choi so we can focus on whether, and how to include it? WLU (t) (c) Misplaced Pages's rules:/_complex 17:04, 22 May 2013 (UTC)

Created below. WLU (t) (c) Misplaced Pages's rules:/_complex 17:24, 22 May 2013 (UTC)

Here are a few secondary sources that might help inform your consensus-building:

• Electrical Characterization of Acupuncture Points: Technical Issues and Challenges Ahn 2007
• Characterizing Acupuncture Stimuli Using Brain Imaging with fMRI - A Systematic Review and Meta-Analysis of the Literature Huang et al 2012
• How do acupuncture and moxibustion act? - Focusing on the progress in Japanese acupuncture research Kawakita et al. 2006
• Neuroanatomical basis of acupuncture treatment for some common illnesses Cheng 2009

Puhlaa (talk) 17:29, 22 May 2013 (UTC)

• Ahn, 2007 is pretty old, six years, and is probably redundant to Colbert et al. 2011 which is already on the page (and includes Ahn as a co-author).
• Cheng, 2009 perhaps, but again is speculative.
• Kawakita, 2006 is pretty old, focusses on Japanese acupuncture and moxibustion, but might be useable.
• Huang et al 2012 is recent and could probably be used, but again comes down to "there's no consensus and more research is needed".

Again these sources are long on speculation and short on consensus, often with competing models. Worth a mention, certainly not appropriate for saying "acupuncture is effective through X mechanism". I would see it basically as a list of possible explanation without much more text than that list. WLU (t) (c) Misplaced Pages's rules:/_complex 18:03, 22 May 2013 (UTC)

I have not seen anyone suggest that the text be changed to say "acupuncture is effective through X mechanism", I have only seen Acuhealth critique the current article lead, based on his/her assertion that it is POV and uses weak sources. The sources I provided are all peer-reviewed and secondary sources. The sources all seem to agree that some evidence suggests the possibility of some point specificity, but most interpretations beyond that are speculative. The current lead uses 3 sources to support the text "Scientific investigation has not found any histological or physiological correlates for traditional Chinese concepts such as qi, meridians and acupuncture points", however, 2 of those sources are not peer-reviewed (the critical narrative 'trick or treatment' and the 'Chinese medicine times'). The single peer-reviewed source included there says "Based on this review, the evidence does not conclusively support the claim that acupuncture points or meridians are electrically distinguishable. However, the preliminary findings are suggestive and offer future directions for research based on in-depth interpretation of the data"; this is not the same as "not found any histological or physiological correlates", as is currently stated in our lead. I would suggest qualifying the statement in the lead about 'physical correlates' with some acknowledgement that there is indeed a debate based on scientific investigation, because "preliminary findings are suggestive" - however "the evidence does not conclusively support the claim that acupuncture points or meridians are distinguishable".Puhlaa (talk) 19:52, 22 May 2013 (UTC)

That all said, if consensus is reached, it would be more appropriate to update the body of the article to reflect any "preliminary research" that is discussed in the available secondary sources, before the lead is updated (IE: lead should summarize the body).Puhlaa (talk) 19:56, 22 May 2013 (UTC)

Agreed, an update to the body seems appropriate. I argue that the lead is misleading and needs the half-sentence redaction based on the editorial editor mistake of citing references inappropriate to the content and refusal to remove them although addressed fully in TALK. TriumvirateProtean (talk) 23:57, 22 May 2013 (UTC)

I see that correlates has now been changed to "existence". This is a bold step given the ongoing controversy over the statement. At minimum, needs undo. There is no TALK prior to the edit and the sources quoted are in question and consensus is in development over secondary sources showing correlates and existence.TriumvirateProtean (talk) 03:53, 23 May 2013 (UTC)

As previously explained, NPOV requires the inclusion of opposing POV and controversies. Just because they do not agree with other content is no reason they should be removed. On the contrary. That would be whitewashing. Controversies should be stated plainly and not hidden.

The word "correlates" has been added at some point and has been creating problems. It's too vague and was not the original term used, where lack of proof of "existence" of qi, meridians, and acupuncture points was the more precise wording which expressed the precise POV of skeptics. I have restored that wording so the idea is clear. Obviously this conflicts with basic acupuncture theory and the views of proponents. That's the way it is in fact, and that's the way the article should state the conflict between the two world views. I have made two edits to restore the previously clear content. If believers do not believe that content, then I have achieved the proper purpose by making the conflict plain. If improvements can make it even plainer and with better prose (and which also follows the references), then do so, but don't whitewash it or delete it. -- Brangifer (talk) 03:57, 23 May 2013 (UTC)

People are entitled to their beliefs and opinions, however, they are not entitled to skew facts. There is plenty of scientific research documenting the existence, structure and physiological properties of acupuncture. More than this, it could be stated that, "Many people believe that there is no scientific proof...., however, x and such studies have shown physiological properties, etc..." Note that the sources in that statement are not secondary, peer reviewed sources and are quire controversial. Yes, the controversy is hidden and covert in that the references do not support the claim. TriumvirateProtean (talk) 04:04, 23 May 2013 (UTC)

Which "references do not support the claim"? The skeptical references support the skeptical claims. That's all that's necessary for those claims. -- Brangifer (talk) 04:23, 23 May 2013 (UTC)

Perhaps illuminating the controversy, as you suggest, is intellectually honest. I suggest that I add some of the research presented in this section stating, "Numerous studies using MRI imaging demonstrate acupuncture point specific responses in brain EEG readings. Hemodynamic and oxygen pressure studies show anatomical physical correlates for acupuncture points." Then, of course, including the references.TriumvirateProtean (talk) 04:14, 23 May 2013 (UTC)

No, don't add that. It would just be deleted. They are primary research that prove nothing other than that brain cells are connected to body parts. Big deal. No evidence for or against acupuncture. As you say, "people are entitled to their beliefs, however they are not entitled to skew facts." That cuts both ways, and the beliefs of those who believe in acupuncture are just as much belief as anything else. Also read MEDRS. Your insistence on using poor and primary sources is not constructive.

Above I asked a question, but you have not responded, so I'll ask it again: What is your exact position(s) at Five Branches University and Healthcare Medicine Institute? -- Brangifer (talk) 04:21, 23 May 2013 (UTC)

Honestly, Brangifer, if I was Acuhealth I really wouldn't bother to respond. I can understand that you want to prevent WP:COI, however, trying to coax someone into WP:OUTING is not helpful. Cheers, --Mallexikon (talk) 07:24, 23 May 2013 (UTC)

Returning to the substantive topic at hand, Trick or Treatment is a valid, reliable source, and it and the other sources stating "no correlates of acupuncture points" are still correct. The best that has been provided alleging acupuncture points exist are really possible biological correlates of the actual points. They are not definitive, they are not universally accepted, they are not conclusively proven. If you go to a major centre like the NIH, or a current textbook, these sources do not say "acupuncture points are now identified as ____". Ahn, 2008, is accurately summarized - the "results" are suggestive of future research. Not conclusive. I see no reason to change the lead, bar perhaps adding something like "...though some possible structures have been suggested and research is ongoing." However, I consider such statements to be pointless wastes of words and would personally prefer such a change not be made. There is certainly not an adequate amount of scientific research documenting the existence, structure and properties of acupuncture. As said previously, the best evidence I've seen so far is suggestive, not conclusive. At best you could point out what avenues are being pursued - but certainly not based on primary sources, secondary only.

I have no problem with either "correlates" or "existence". I lean more towards the latter.

The problem with Acuhealth isn't his or her possible COI, it's the poor quality of the references being presented to verify a change. I don't care what Acuhealth does in meatspace, I do care that his/her references are inadequate. WLU (t) (c) Misplaced Pages's rules:/_complex 13:06, 23 May 2013 (UTC)

References

I've put in a reflist so I can see the actual studies, if anyone knows how, can they throw in one o' them fancy boxes that doesn't mess with the formating? WLU (t) (c) Misplaced Pages's rules:/_complex 16:29, 22 May 2013 (UTC)

Choi et al

The above sections are a mess, per my own suggestion, here's a new section to discuss the one source that might be worth including: Choi et al, 2012. Discussing sham acupuncture controls, it states "The difference between sham and verum acupuncture remains unclear." It then goes into why. This is an interesting discussion that could be included in some form, but the equivocal nature must be reflected. The article does not indicate a consensus exists.

Next is a discussion of pain studies, which opens with "The majority of studies refuting the principle of point specificity evaluated the role of acupuncture in pain relief." Again, it discusses why, and again it's equivocal but useful in contextualizing future possible research.

Next is a discussion of "hemodynamic" studies - heart rate and blood pressure. This section would need to be treated with great caution, mixing electroacupuncture, exercise, rat and cat studies. Amazingly to me, they only cite four studies, but somehow draw conclusions from them. I really wonder if some cherry-picking is occurring. Why these four studies? Why the focus on exercising subjects (two studies), rats (one study) and cats (one study)? Is that the sum of the literature? Overally I would say this section is "suggestive" of point-specific responses, but no slam-dunk. It really reads like shit research.

Next is neurological studies - fMRI stuff. Similar to the hemodynamic section, it's really just summaries of single studies - why those studies? Why cats again? While they say "The point-specific actions resulting from stimulation of different acupoints in controlled laboratory trials confirm that needling different points on the body produces more than just placebo responses, given that placebo acupuncture is not associated with differential or acupoint-specific responses in anesthetized animals" the bold part seems quite relevant - people aren't cats.

Overall, given the totality of literature that exists for acupuncture, this seems like a shoddy, shallow, cherry-picked selection of evidence that is unduly extrapolated to humans. If this were my wikipedia, I wouldn't cite it at all. I'd probably mock it. However, since it's not my wikipedia, at best I would give it one sentence saying there is some evidence that certain points may have specific effects. WLU (t) (c) Misplaced Pages's rules:/_complex 17:23, 22 May 2013 (UTC)

Tough room. OK, let's try a more heavy weight study on the specific physiological responses evoked by acupuncture. The Annals of Internal Medicine is widely accepted as is the University of Maryland School of Medicine from which the lead author hails. As with an investigation, there are limitations but this finding is in agreement with your assertion that one sentence saying there is "some evidence" is appropriate. I don't think this research is worth mocking. TriumvirateProtean (talk) 17:33, 22 May 2013 (UTC)

That's Berman et al. 2004. It's 9 years old, it's a primary source, and it's only talking about one specific type of pain - osteoarthritis. Of the knee. The page already discusses acupuncture and the knee using several much more recent meta-analyses. It also has no bearing on the possible mechanism for acupuncture effectiveness. It doesn't add anything to Choi et al. WLU (t) (c) Misplaced Pages's rules:/_complex 18:07, 22 May 2013 (UTC)

Agreed, unrelated to Choi. I wasn't sure where to put it since it was an effort to reference physiological responses. Maybe move this comment to a better section?TriumvirateProtean (talk) 18:12, 22 May 2013 (UTC)

I wouldn't bother since there's no reason to expect it will be integrated into the page or used to verify any text. It's redundant to other sources. WLU (t) (c) Misplaced Pages's rules:/_complex 18:44, 22 May 2013 (UTC)

Correlates vs existence

"Scientific investigation has not found any histological or physiological proof for the existence of qi, meridians, and acupuncture points..." is an awkward sentence. Qi, meridians etc. are (at the least) concepts that are existing in the theory of TCM (I think we can all agree on that). That's why the original wording (before it was changed by Brangifer) was "scientific investigation has not found any histological or physiological correlates for traditional Chinese concepts such as qi..." - which is both more elegant and more precise. So I changed it back. Cheers, --Mallexikon (talk) 06:42, 23 May 2013 (UTC)

Zhang, 2010

I'm surprised this systematic review isn't cited WLU (t) (c) Misplaced Pages's rules:/_complex 18:33, 23 May 2013 (UTC)

• Attention: This template ({{cite pmid}}) is deprecated. To cite the publication identified by PMID 20145733 , please use {{cite journal}} with |pmid=20145733 instead.

Needles

One line in the article: "Japanese acupuncturists use extremely thin needles that are used superficially, sometimes without penetrating the skin, and surrounded by a guide tube (a technique adopted in China and the West)" seems to need a citation for the part "without penetrating the skin." It is commonly known that 'Japanese' style needles come in very thin gauges and common practice in China uses thicker gauges so this part requires no citation. The "without penetrating the skin" assertion is not common knowledge and I have never heard of this. I am curious, however, to hear more about it. Also, the penetration aspect might be better put in the technique subsection and not in the needle section heading which deals with the makeup of the needle.TriumvirateProtean (talk) 18:50, 23 May 2013 (UTC)

I'd like to see someone add a section comparing wound needle handles with pipe handles. Also, comparison of metals used in needles is of interest. Moreover, a comparison of classical Chinese needle design with Korean and Japanese style needle design. In addition, there is no mention of the silicone coated needle vs. the uncoated needle- a major area of needle design and highly relevant to comfort levels.TriumvirateProtean (talk) 19:00, 23 May 2013 (UTC)

It is already sourced, citation 74, this book.

If you want to see a section added, find the necessary sources and add it. WLU (t) (c) Misplaced Pages's rules:/_complex 11:01, 24 May 2013 (UTC)

Needle Technique

"The skin is sterilized, e.g. with alcohol, and the needles are inserted, frequently with a plastic guide tube." I see that a citation has been requested. This is necessary in that plastic guide tubes are frequently used outside of China more than within China. Classical acupuncture insertion technique does not involve the use of a guide tube. Perhaps mention of the geographic region where they are more frequently used than other regions. This also goes to the gauge discussion between Japanese Style and Chinese style needles wherein there are geographic differences in equipment use.TriumvirateProtean (talk) 19:00, 23 May 2013 (UTC)

The citation was already there. If you wish to add more information, you will have to find reliable sources and expand the page with them. WLU (t) (c) Misplaced Pages's rules:/_complex 11:11, 24 May 2013 (UTC)

It is true that guide tube use is not common in China, but very common in Japan and the west. Perhaps the Clean Needle Tech manual addresses this.Herbxue (talk) 17:32, 26 May 2013 (UTC)

Acupuncture usage in the US military and other military forces

Very sorry, but I just can't see the merit of those sections. Maybe it's because I'm European. Anyways, this is supposed to be an encyclopaedic article informing people on the topic of acupuncture; whether the US army or the Iranian mullahs or the German postal service like acupuncture is really irrelevant. A1candidate, if you think this army stuff is encyclopedic material, please create a proper article about it. Otherwise, I'd just delete it. Cheers, --Mallexikon (talk) 02:58, 27 May 2013 (UTC)

Im not sure why you claim that your European heritage should influence your judgement on my work, I thought the usage of acupuncture in armed military forces would probably be interesting for 99% of readers out there. What do other editors here think? -A1candidate (talk) 06:21, 27 May 2013 (UTC)

I'm ambivalent. "Battlefield Acupuncture" is certainly notable in the U.S., though it does not add to understanding Acupuncture on its own terms. However, the question of whether acupuncture is "mainstream" or not is often raised. For this reason, I would say it should be included.Herbxue (talk) 14:40, 28 May 2013 (UTC)

Reverted edits by Mallexikon

I've reverted edits by Mallexikon because there was no consensus for its removal. See discussion above. -A1candidate (talk) 06:33, 17 June 2013 (UTC)

I have to agree with Mallexikon. It's not relevant to the topic of this particular article. Dominus Vobisdu (talk) 08:12, 17 June 2013 (UTC)

Suggestion: Current research and recommendations

Im wondering if its a good idea to add a new subsection called "Current research and recommendations" (by authoritative PUBLIC/GOVERNMENT INSTITUTIONS ONLY). Would that be a useful addition to the article? The following table and text is intended as a draft:

As scientific studies on accupuncture have so far produced mixed results, the effectiveness of accupuncture has become a controversial issue. Also, the exact mechnanism of acupuncture is still unknown, which further complicates the matter. The following table is intended to give an authoritative view of acupuncture based on recommendations by government institutions and supranational organizations:

Country	Authority	Guidelines	Last update
United States	National Institute of Arthritis and Musculoskeletal and Skin Diseases	Acupuncture may improve knee function among patients with osteoarthritis It serves as a complement to standard care	July 2010
	National Institute of Child Health and Human Development	Some research indicated benefits from acupuncture, especially when given immediately after severe traumatic brain injury	November 2012
	National Cancer Institute	Studies have shown that acupuncture changes the response of the body's immune system It may stimulate nerve cells, the pituitary gland, and parts of the brain There is strong evidence that acupuncture relieves nausea and vomiting caused by chemotherapy For many cancer patients, acupuncture treatment either relieves symptoms or keeps them from getting worse. Few complications reported	March 2013
	National Institute of Neurological Disorders and Stroke	Acupuncture is recommended as a treatment option for chronic pain Experiments have shown that acupuncture may lead to higher levels of endorphins in cerebrospinal fluid	May 2013
United Kingdom	National Health Service	Acupuncture is recommended as a treatment option only for lower back pain There is some evidence that acupuncture works for a small number of other conditions including migraine and post-operative nausea Serious side effects are extremly rare More research is needed	May 2012
Germany	Bundeswehr Joint Medical Service	Acupuncture points on the body contain free nerve endings and nociceptors Acupuncture has been successfully used to reduce pain during operations It is effective in treating bodily dysfunctions such as migraine and dyspepsia The main results of acupuncture are not caused by the placebo effect	April 2013
N.A.	World Health Organization	The diseases or disorders for which acupuncture therapy has been tested in controlled clinical trials can be classified into four categories: Effect of acupuncture has been proven Effect of acupuncture is shown but further proof is needed Accupuncture is recommended because treatment by conventional therapy is difficult Acupuncture may be tried out The full list of treatable diseases and disorders is available [here	2003

Any suggestions/feedback? -A1candidate (talk) 21:03, 28 May 2013 (UTC)

Yeah, I'm against this. The question of who is pro and who is contra acupuncture is overblown in our article already. And while it might be of interest what medical organizations think about it, I'd like to emphasize again that the opinion of the armed forces (or the police or whatever government institution) is irrelevant here. Cheers, --Mallexikon (talk) 04:54, 29 May 2013 (UTC)

Malexikon, I am not necessarily "for" this, but I am curious, why do you say it is irrelevant? Of undue weight perhaps, but what determines what is relevant or not for this article?Herbxue (talk) 06:10, 29 May 2013 (UTC)

Very good question. Common sense, I guess. --Mallexikon (talk) 06:32, 29 May 2013 (UTC)

Hmmm, that's flippant (and funny), but doesn't seem like a reliable rubric. If, for example, an American illustrator's take on TCM's attitude towards anatomy is considered relevant and reliable for reporting on TCM's purported ignorance of anatomy (because it is a "secondary source"), why can't the findings of an agency tasked with making heath care recommendations be considered a reliable and relevant secondary source?Herbxue (talk) 06:56, 29 May 2013 (UTC)

@Mallexikon: As a new editor of this artice, my main concern is the lack of authoritative sources that the general public can trust. When I first looked at the article it was confusing because it contradicts itself in many sections. IMHO, the benefits of citing from government institutions are:

• Official guidelines/recommendations are updated regularly, which reduces the need to add/include every single scientific study
• A clear line is drawn to separate what's proven from what's not proven
• The table summarizes all scientific findings in a way understandable to the general reader

-A1candidate (talk) 07:01, 29 May 2013 (UTC)

@Herbxue: I don't mind stating what agencies "tasked with making health care recommendations" have to say about acupuncture... The armed forces of the US and Germany hardly fall under that category, though. --Mallexikon (talk) 08:46, 29 May 2013 (UTC)

Ok thanks, I thought you meant all the proposed sources were irrelevant.Herbxue (talk) 14:13, 29 May 2013 (UTC)

I would agree with Mallexikon here, the recommendations of the WHO are clearly relevant as a body of medical experts while the opinions of the armed forces of some few (select) countries are hardly relevant for the article. Also relevant could be recommendations of medical bodies and scientists associations. However, I would now follow A1candidate completely and we should not blindly trust governmental bodies to summarize the research appropriately because governments have their own agenda while peer-reviewed, reputable scientific publications are generally less biased. Greetings --hroest 11:49, 29 May 2013 (UTC)

That is mostly true, what we could perhaps do is gather everything regarding the effectiveness of acupuncture into one section and split it into four parts:

• Recommendation by WHO
• Guidelines and research by government institutions
• Results by reputable scientific publications and academic organizations:
  • If the results support the above guidelines then there's no point including them again unless they're highly notable
  • If the results do not support the above guidelines then they should be included
• Criticism

Is there consensus that this would make the article better than its current state? Im pretty sure we could condense the entire resarch and findings if and when acupuncture ever becomes an established science, but as long as it remains a controversial topic, I think organizing the article this way would give it a better structure.-A1candidate (talk) 12:15, 29 May 2013 (UTC)

I still think listing the opinions of all those institutes is a waste of article size. Those institutes base their recommendations and views on exactly the same sources we already have in the article - yes, acupuncture might be a good idea for back pain, and yes, for nausea, too, even if the mechanism of action is still not understood, etc., etc... Duh! I guess I can't argue against stating what these institutions recommend (although I regard that as information of very limited value), but I would definitely leave their summaries regarding the current state about what is scientifically known about acupuncture out - it's just redundant. We've already listed all of that in earlier sections. Cheers, --Mallexikon (talk) 01:57, 30 May 2013 (UTC)

That is indeed true to a certain extent, but I would argue that the includsion of the guidelines will draw a clear line separating what works, probably works, and doesn't work. So far, the reader has to read every single study in order to draw definite conclusions that require a considerable amount of medical knowledge. If you can organize the entire research into a way that draws a DEFINITE conclusion about acupuncture then I would certainly support it -A1candidate (talk) 06:43, 30 May 2013 (UTC)

Yeah, I would support that, too :)... however, to use the NHS's words, current "evidence does not allow us to draw definite conclusions..." It's as messy at that. No convenient way out for the reader, I'm afraid. Cheers, --Mallexikon (talk) 09:09, 30 May 2013 (UTC)

Yes, but if you look at my table I've included the part where NHS says that more research is needed. The peoblem is that this article contains numerous assertations by people/organizations with questionable notability. There is even a lengthy quote by an organization that doesn't have its own Misplaced Pages article. I hope you understand why its difficult for the general reader to draw a definite conclusion here. Lets see what other editors think, shall we? -A1candidate (talk) 10:17, 30 May 2013 (UTC)

Suggestion: Mechanism of action

Acupuncture#Possible_mechanisms currently consists of a single sentence, that's IMHO inadequate for such a large topic. Here's an explanation of the mechanism by the Johns Hopkins School of Medicine (Source):

• Conduction of electromagnetic signals (which releases substances like endorphins)
• Activation of the body's natural opioid system
• Stimulation of the hypothalamus and the pituitary gland
• Change in the secretion of neurotransmitters and neurohormones

This can be backed up by the following quotes published on various scientific journals:

• Nature (journal): "...We found that adenosine, a neuromodulator with anti-nociceptive properties, was released during acupuncture..." (Source)
• Journal of Endocrinology: "...Acupuncture blocks cold stress-induced increases in the hypothalamic–pituitary–adrenal axis..." (Source)
• Oxford Journal:"..The acupoints are located at sites that have a high density of neurovascular structures and are generally between or at the edges of muscle groups..."(Source)
• Peptides (journal):"..These data suggested that AVP (Arginine vasopressin) in the brain played a role in the process of acupuncture analgesia in combination with the endogenous opiate peptide system.." (Source)
• Radiology (journal):"...Results from human and animal studies (2,9–13) suggest that acupuncture acts as a neuromodulating input into the central nervous system (CNS) that can activate multiple analgesia systems and stimulate pain modulation systems to release neurotransmitters such as endogenous opioids..." (Source)
• The American Journal of Gastroenterology:"...The more remarkable modulation on the homeostatic afferent network, including the insula, ACC, and hypothalamus, might be the specific mechanism of acupuncture." (Source)
• The Lancet:"...After electroacupuncture in the patients with pain CSF β-endorphin levels rose significantly in all subjects, but met-enkephalin levels were unchanged. These results suggest that the analgesia observed after electroacupuncture in patients with recurrent pain may be mediated by the release into the CSF of the endogenous opiate, β-endorphin..."(Source)

The biggest challenge would probably be presenting the information in a way that's understandable to the general reader who does't have much much medical knowledge. -A1candidate (talk) 08:55, 30 May 2013 (UTC)

True... how about: "besides a lot of theories and suggestive findings, no hard evidence for any specific mechanism of action exists so far"? --Mallexikon (talk) 09:09, 30 May 2013 (UTC)

There is actually one specific mechanism that has been proven numerous times - Acupuncture does lead to the release of natural opioids. I dont know if you're medically trained so I wont go into details, but this should be mentioned in the article. Lets just see what other editors say, shall we? -A1candidate (talk) 10:13, 30 May 2013 (UTC)

I have always supported mentioning all of these mechanisms. The question of "which one" is "THE" mechanism explaining acupuncture is not an important question to me. All of these journals note specific physiological effects of acupuncture needle stimulation. There is no 1:1 correspondence between the traditional theories of how acupuncture works and the various physiological responses that have been experimentally observed. Each phenomenon is notable on its own terms.Herbxue (talk) 21:05, 30 May 2013 (UTC)

Why not approach this topic in a way similar to how other medical articles would deal with interventions with unknown mechanisms. For example, at the article for antidepressants the section on mechanism of action starts with an admission that no one knows how they work, then the most probable theories are detailed.Puhlaa (talk) 00:59, 31 May 2013 (UTC)

Agreed.Herbxue (talk) 21:19, 2 June 2013 (UTC)

ATP addition

Besides undue weight, the recent addition of a section on ATP violates MEDRS. It's primary research. It is not specific to acupuncture and doesn't "prove" acupuncture. It was done on mice, not humans, so what about acupuncture points? It just tells what happens when the bodily tissues of mice are damaged, including damage caused by acupuncture needles. The human body apparently reacts in a similar manner when damaged. Interesting. The addition of reactions in the press doesn't improve the matter and doesn't lend more weight to the findings, although I can't think of any other possible reason for adding them. Otherwise the research is interesting. -- Brangifer (talk) 14:14, 31 May 2013 (UTC)

It's not about whether its interesting or not, this study is central to the understanding of acupuncture, which is not exclusively used on humans. The study itself is notable enought to deserve a standalone article, I think its just fair to summarize it briefly here -A1candidate (talk) 14:23, 31 May 2013 (UTC)

Read MEDRS. You have added huge amounts of primary research, commentary, OR and synth violations. Start discussing each single edit before you make it. You're not going to use this article as your personal blog. -- Brangifer (talk) 15:34, 31 May 2013 (UTC)

Brangifer beat me to it, as I was intending on reverting the lot of your changes to the article myself because they violate WP:NOR and WP:MEDRS. Also agree that it was begining to look like a blog or persoanl essay. Any medical claims have to be backed up by rock-solid peer-reviewed secondary sources per WP:MEDRS. Primary papers are out of the question except to illustrate and supplement what is said about them in the secondary sources. Propose changes one at a time here and get clear consensus first. Dominus Vobisdu (talk) 15:50, 31 May 2013 (UTC)

These studies can all be backed up by secondary sources, lets start with Adenosine Triphosphate since this seems to be the major point of contention. I cited the primary sources for historical reasons, but here are some secondary sources:

• Medical textbook by Springer Publishing: "...Additional observations have implicated tissue release of nucleotides and adenosine in acupuncture analgesia, and shown analgesia results from peripheral actions at adenosine A1Rs... " (Source)
• Review article by Evidence-based Complementary and Alternative Medicine: "... These data strongly suggest that acupuncture-released ATP and its metabolite adenosine in local acupoint tissues block pain impulses from sites distal to needling point...." (Source)
• Review article by the Pflügers Archiv: European Journal of Physiology: ...In a separate study, the mechanistic action of acupuncture was observed by focusing on adenosine. It was found that insertion and manual rotation of acupuncture needles triggered a general increase in the extracellular concentration of purines, including the transmitter adenosine and ATP metabolites..." (Source)
• Review article by Neuropsychopharmacology (journal): "...In another recent study, Goldman et al. (2010) found that localized A1R activation underlies the antinociceptive effects of acupuncture. Manual stimulation of acupuncture needles resulted in localized extracellular increases in nucleotides (ATP, ADP, and AMP) and adenosine...'" (Source)

If there are any other issues or any suggestions/feedback, I'll be happy to address them. -A1candidate (talk) 18:37, 1 June 2013 (UTC)

Yeah, well... that's a very unspecific effect for an invasive procedure. If you punch someone hard enough you'll find lots of nucleotides and adenosine in the tissue as well... probably a few extravasal red blood cells and some histamine, too... On top of that, you keep on citing single studies (or in this case, the articles you cite are citing single studies)... That's not really what we need here - it inevitably leads to cherry picking. The aim is to report scientific consensus. --Mallexikon (talk) 06:07, 2 June 2013 (UTC)

The bigger problem here is relevance. Like Mallexikin said, the effect observed is hardly surprising, and does little to explain the phenomenon. Dominus Vobisdu (talk) 08:10, 2 June 2013 (UTC)

I see these mechanism studies as relevant, because this is information people want to know about Acupuncture. If you are unwilling to buy into traditional theory, what possible explanation can there be for the specific or non-specific effects of Acupuncture? I think that is a relevant question the article already seeks to answer.Herbxue (talk) 21:23, 2 June 2013 (UTC)

Yes, mechanism is relevant, but we need MEDRS sources, not primary studies. Using such sources creates an OR problem, because anyone can cherry pick any primary studies to paint the picture they wish. That's not acceptable here. When there are large reviews of many quality studies, then we can talk about inclusion of such information. Until then we continue to follow MEDRS for inclusion AND exclusion of sources making biomedical claims. These are excluded. -- Brangifer (talk) 22:35, 2 June 2013 (UTC)

I would argue that unless a medical claim of efficacy is being made, the following statement from MEDRS applies: "Sources for all other types of content—including all non-medical information in medicine-related articles—are covered by the general guideline on identifying reliable sources rather than this specific guideline." - the question of what happens physiologically when a needle is inserted in flesh is a general scientific question, rather than a medical question such as "does acupuncture effectively treat migraine" - thus primary sources are appropriate for the kind of content this article is missing.Herbxue (talk) 05:36, 3 June 2013 (UTC)

You misunderstand our general criteria with using primary sources on wikipedia. We almost never use primary sources so as to avoid original research. Primary sources should only be used to augment secondary sources. Primary sources can only be used for basic descriptive statements. IRWolfie- (talk) 11:21, 3 June 2013 (UTC)

The sources being discussed here are all secondary sources, mostly review articles -A1candidate (talk) 12:48, 3 June 2013 (UTC)

The fourth source you cited () is not secondary (they talk about their own research). The first 3 sources (, , ) actually are secondary. In none of them, however, can I find mention of adenosine being a major element in the mechanism of action of acupuncture - what statement would you like to use these sources for, then? --Mallexikon (talk) 03:57, 4 June 2013 (UTC)

The fourth citation is a review article based on the findings of other scientists. Perhaps you may wish to read the parts I've highlighted in bold.-A1candidate (talk) 06:46, 4 June 2013 (UTC)

Yes, they do review the works of other scientists, but just as a framework for their own studies ("In the first set of studies, our lab found that...") - this is probably something between a primary and a secondary source. The important point here is, however, that they can't be perceived as an independent source (as in: "Whenever writing about medical claims not supported by mainstream research, it is vital that third-party, independent sources be used..."). Cheers, --Mallexikon (talk) 01:17, 5 June 2013 (UTC)

I beg to differ; if you look at the first source its actually a medical textbook which summarizes consensus on this topic. Much of the controversy/disagreement has been centered on the clinical effectiveness of acupuncture alone, and not on its mechanism. So far, I haven't seen a single source say that acupuncture doesn't lead to higher adenosine/ATP levels. If you find one that says so, then Im highly interested to take a look at it -A1candidate (talk) 06:15, 5 June 2013 (UTC)

I sincerely hope you're not deliberately misunderstanding me... So let me repeat: a) My comment directly above refers to the 4th source you mentioned, not the 1st one. b) The 1st, 2nd, and 3rd of your sources do constitute secondary sources, however, in none of them can I find mention of adenosine being a major element in the mechanism of action of acupuncture - so what statement would you actually like to use these sources for? --Mallexikon (talk) 06:45, 5 June 2013 (UTC)

These sources don't explicitly say that because its assumed the reader already has some medical knowledge and knows what adenosine is. If that isn't the case the case for you, I apologize. If you want a source that explicitly states the obvious, here you go: "...AMP and adenosine concentrations remained increased after acupuncture and enhanced the duration of the pain-relieving effects of acupuncture. This work provides a mechanism for the basis of acupuncture..." (Science Signaling) -A1candidate (talk) 07:05, 5 June 2013 (UTC)

I still don't see evidence of a specific effect attributable solely to acupuncture or to stimulation of specific acupuncture points. What I see is some evidence that when one sticks a needle in the body, in this case an acupuncture needle, and especially when one twists it, one sees a reaction. A good experiment would check for similar reactions, measuring the same changes, using other types of stimuli, and also when other bodily points are stimulated/affected. Now THAT would be interesting! If there were differences that were beneficial and solely attributable to acupuncture needles on specific acupuncture points, THAT would be significant. We haven't seen anything close to that yet. If we had secondary reviews of multiple studies of good quality that are independently reproduced (that's what we mean by MEDRS compliant) that showed such evidence, we'd have them put into this article so fast your head would spin, but they don't seem to exist. Please provide us with such sources when you find them. We need controlled studies using control groups and methods, with as much blinding as possible. -- Brangifer (talk) 07:14, 5 June 2013 (UTC)

@A1candidate: This Science Signaling source you provided is - again - dealing with a single study (the one from Goldman et al.) - this just doesn't cut it for a MEDRS. And the 3 secondary sources we talked about are not being explicit about adenosine being a major element for the mechanism of acupuncture action simply because they recognize that it's just one of the factors in acupuncture analgesia (actually, in analgesia in general) - not, as you suggest, because "its assumed the reader already has some medical knowledge and knows what adenosine is" (on the contrary: everybody who knows what adenosine is would also know that its release into the tissue is quite common in all kinds of tissue trauma). --Mallexikon (talk) 08:26, 5 June 2013 (UTC)

A separate study by Zylka et al would probably be of interest; it also confirms the earlier discovery by Goldman et al by exploiting their findings -A1candidate (talk) 15:44, 8 June 2013 (UTC)

(Sigh)... great, another single study!... I can't access this article (at Nature; actually I could, but I don't want to spend the 15€ they want for it), but I read that he also experimented with mice. So, no, this doesn't cut for a MEDRS (again), but I think it might be interesting to discuss this mice acupuncture phenomenon. Please see the new thread I started below. Cheers, --Mallexikon (talk) 04:58, 9 June 2013 (UTC)

I am not sure that I understand the strong resistance to include information for the reader with regard to theoretical mechanisms of action of acupuncture. I note that the section of the antidepressant article includes primary studies, including some animal model studies using mice. I see no problem including this kind of information here, EG: The ATP hypothesis, the endorphin hypothesis, the Qi hypothesis, etc. Provided the section is not making medical claims, only informing the reader with regard to current theory, I think we can loosen MEDRS, as was done at the antidepressant article.Puhlaa (talk) 05:13, 9 June 2013 (UTC)

Acupuncture on mice

Yeah, just off the top my head: two thoughts.

1. Measuring pain reduction is not that easy in studies (since it's a feeling), so it's usually tested by having your test subject use a pain scale... So how can you measure pain reduction in mice (measuring their stress hormone levels? Functional MRI?...) and how reliable can that possibly be?
2. I've never seen any historic acupuncture charts for mice and I assume none of the old Chinese put much empiric research into that... So how can we know where the acupuncture points are on a mouse (e.g., an important point like Zusanli/St36)? And even if we could find a (reliable) way of finding out: how on earth can you make sure you really hit those points with your needles? I understand it's not always easy to accurately hit the points even in human patients (whose anatomy is not quite as minuscule and who at least can tell you if they get a de-qi sensation)... --Mallexikon (talk) 04:58, 9 June 2013 (UTC)

By measuring the amount of purines and adenosine, and how quickly each mouse pulled its paw away from stimuli. The more pain the mice were in, the faster they pulled away. The Weizhong acupuncture point is located at the popliteal fossa. -A1candidate (talk) 07:20, 9 June 2013 (UTC)

So what they measured basically was that if you put a needle into a mouse's popliteal fossa, it will pull its paw away from stimuli much slower...? --Mallexikon (talk) 09:16, 9 June 2013 (UTC)

Indeed! This is truly mind blowing! What can I say but "duh"...? Yes, it's interesting pathophysiology, but still no proof for acupuncture, and still totally ineligible here per MEDRS. When a "scientist" like Zylka takes assumptions (that the dots on ancient drawings of acupuncture points have real histological and unique correlates) and then does research without first overwhelmingly proving those assumptions are true to the satisfaction of 95%+ of other scientists, Zylka is over in deep pseudoscience. That's why I put "scientist" in quote marks. Zylka's credibilty is approaching zero. At Misplaced Pages we'd call use of this source a violation of MEDRS, among other things. We still need to see properly controlled studies, then reviews of multiple duplications of those studies, then wide acceptance. None of that has happened yet. -- Brangifer (talk) 17:19, 9 June 2013 (UTC)

The question is really whether or not this is an acceptable source based on guidelines I guess. The question of whether or not needling an animal and measuring the reaction is applicable to understanding Acupuncture is a yes as far as I can tell. Does it prove that that point has a relationship to the "stomach" or that it is the "earth point of the earth channel"? Of course not. It may only tell us about non-specific effects of acupuncture, or specific effects other than the intended effects, but it is still valuable to know.Herbxue (talk) 14:51, 10 June 2013 (UTC)

I agree. It's very interesting from a pathophysiological standpoint. What happens when one needles the body, or provokes it with other measures? That's always interesting, because sometimes we find out something that is predictable and also useful. As far as traditional Chinese acupuncture theory, etc., I'm not sure we're any closer to proving anything that backs it up, but needling does have some effects, just as other ways of stimulating the body do, and they may work just like the elephant effect: If your finger hurts and an elephant steps on your foot, you no longer feel the pain in your finger. Even nonspecific actions can have general effects that relieve pain. So far it seems that it makes no difference where one sticks an acupuncture needle to get a pain relieving effect, which basically means that acupuncture, as a system, is humbug. General pain relief seems to be one thing that's generally agreed upon, even if it's inconsistent, unpredictable, and nonspecific. The question of worth then comes into play. When one can get more specific and predictable results using other methods, why use acupuncture? -- Brangifer (talk) 06:57, 11 June 2013 (UTC)

Good points, and I agree that is an important question. But remember acupuncture is a heterogenous practice with many practitioners treating mainly pain and neurological conditions by needling locally (typical in Chinese hospitals) and many practitioners focusing on the more esoteric aspects. If scientific inquiry shows that the more esoteric aspects are just a mental construct that serves to focus or train the patient and practitioner to have certain reactions to stimuli, then so be it. But simply sticking needles into people to stop pain is certainly part of the picture too.Herbxue (talk) 14:05, 12 June 2013 (UTC)

New debate in Anesthesia & Analgesia

Note that these two articles appear in the same edition and reference each other, so the authors were allowed to critique and respond to each other:

• Colquhoun, D; Novella, S (2013). "Acupuncture is theatrical placebo". Anesthesia & Analgesia. 116 (6): 1360–1363. doi:10.1213/​ANE.0b013e31828f2d5e. Retrieved June 2, 2013. {{cite journal}}: zero width space character in |doi= at position 9 (help)

• Wang, S-M; Harris, RE; Lin, Y-C; Gan, TJ (2013). "Acupuncture in 21st century anesthesia: is there a needle in the haystack?". Anesthesia & Analgesia. 116 (6): 1356. doi:10.1213/​ANE.0b013e31828f5efa. Retrieved June 2, 2013. {{cite journal}}: zero width space character in |doi= at position 9 (help)

PS: There is something wrong in the DOI parts of my citation templates above. Please fix.

The conclusions are of most interest, and are definitely quotable. I think skeptics Colquhoun and Novella scored a very strong point by quoting promoters Wang, et al's conclusion. The skeptics said this:

• "Although the article by Wang et al.23 is written to defend the continued use of acupuncture, the only condition for which they claim that there is any reasonably strong evidence is for postoperative nausea and vomiting (PONV). It would certainly be odd if a treatment that had been advocated for such a wide variety of conditions turned out to work only for PONV. Nevertheless, let us look at the evidence."

The actual quote from promoters Wang, et al:

• "In conclusion, clinical trials support the efficacy of acupuncture in reducing PONV and postoperative pain; however, evidence supporting acupuncture as a treatment for chronic pain conditions is mixed."

That the skeptics do not agree, largely because promoters, including Wang et al, make claims far beyond what the evidence supports, and what they themselves (Wang...) have concluded, goes without saying -- Brangifer (talk) 20:53, 2 June 2013 (UTC)

I really find it hard to take sides here... "make claims far beyond what the evidence supports" ... really? He only says that there's rock solid evidence for successfully treating PONV, and that for chronic pain conditions, evidence is mixed. Actually, you could easily turn the skeptics' rationale ("it would certainly be odd if a treatment that had been advocated for such a wide variety of conditions turned out to work only for PONV") around - it actually would be odd, so if the have strong evidence for efficacy in PONV already, the mixed evidence for pain is probably going to turn into solid evidence soon... the reviews we've included in the efficacy section actually seem to pinpoint to that. Cheers, Mallexikon (talk) 02:24, 3 June 2013 (UTC)

He paraphrases them: "reasonably strong evidence is for postoperative nausea and vomiting (PONV)." One need not turn their rationale around, but take if for what they say. That may end up happening for some conditions, and when RS unequivocally prove it, we'll include that here. I don't know what weight Wang, et al have, but if they - promoters of acupuncture - only can state what they said ("clinical trials support the efficacy of acupuncture in reducing PONV and postoperative pain; however, evidence supporting acupuncture as a treatment for chronic pain conditions is mixed."), then there apparently isn't much more than that out there, or they would say it.

What's always nice about quoting one's opponents, is that it makes your case MUCH stronger. A good example is with homeopathy. In spite of all the claims made by homeopaths, when it came right down to it, none of the world's leading pro-homeopathy experts and homeopathy organizations could present good enough evidence to sway the British House of Commons Science and Technology Committee, which stated:

"In the Committee's view, homeopathy is a placebo treatment and the Government should have a policy on prescribing placebos. The Government is reluctant to address the appropriateness and ethics of prescribing placebos to patients, which usually relies on some degree of patient deception. Prescribing of placebos is not consistent with informed patient choice - which the Government claims is very important - as it means patients do not have all the information needed to make choice meaningful.
Beyond ethical issues and the integrity of the doctor-patient relationship, prescribing pure placebos is bad medicine. Their effect is unreliable and unpredictable and cannot form the sole basis of any treatment on the NHS."

If there was more evidence out there for acupuncture, Wang et al would know it and would have said it. I suspect their opinion trumps any cherry picked OR sources in our article. -- Brangifer (talk) 03:21, 3 June 2013 (UTC)

Sounds like you are doing some OR here - one systematic reviewer's failure to properly summarize all of the positive results seen in acupuncture studies is ample evidence for you to say that there is an absence of evidence? Seems like cherry picking of antimatter to me:) Also, the comparison to homeopathy seems inappropriate to me.Herbxue (talk) 05:26, 3 June 2013 (UTC)

I would agree. This is not a CAM forum. Mallexikon (talk) 05:48, 3 June 2013 (UTC)

Proposed New Mechanism of Action Section

I am not a very experienced editor, but have a background in biology and neuroscience. A number of editors have suggested modeling the Mechanism section on the antidepressants page. Here is my understanding of current literature:

The mechanism of acupuncture's effect is unknown. A number of theories have been suggested to explain it:

Placebo

There is some evidence that acupuncture's effect includes a placebo component but this effect incompletely explains acupuncture's effects on pain and eg nausea/vomiting.

Stimulation of Neurotransmitter Release

Acupuncture has been shown to stimulate release of a number of endogenous compounds, including opioids ie endorphins and enkephalins, monoamines, adenosine, ATP and the neurotransmitters involved in Diffuse Noxious Inhibitory Control. None has been definitely shown to be responsible for all of acupuncture's effects in humans.

Gate Control Theory of Pain

This is based on Ronald Melzack and Patrick David Wall's work, that acupuncture stimulates competing nerves which reduce or "gate" pain sensation in the spinal cord. It is not uniformly accepted and does not explain non-pain effects.

Interstitial Transmission Theories

These theories propose that the acupuncture signal is transmitted along non-neural, non-vascular meridian-like networks. These include Becker's bioelectric theory, the Primo Vessel theory and Langevin's Fascial theory. Although Langevin's work is supported by the most evidence, it has yet to be confirmed as the mechanism of acupuncture's effect on pain.

Autonomic Modulation

Originally described by Looney, this theory proposes that acupuncture results in release of various brain chemicals that modulate the autonomic nervous system, to influence a wide variety of organs and systems.

Viscero-Somatic and Somato-Visceral Reflexes Theory

This theory is based upon Felix Mann's work which proposes that acupuncture activates spinal reflexes, thus explaining its visceral effects. Mann has recently distanced himself from supporting acupuncture points and meridians.

Neural Deactivation

There has been recent work suggesting that acupuncture is not directly stimulatory, but, instead, blocks either peripheral nerves directly or blocks the release of brain stress chemicals.

I would appreciate the input of other editors, and, if they deem it appropriate, edit this and then paste into the page!--Tzores (talk) 01:33, 12 June 2013 (UTC)

Wow. Very bold, and very productive. I hesitated incorporating very much of it into the article, though, because when glancing over it it seemed to me there's a lot of primary sources here...? --Mallexikon (talk) 05:59, 13 June 2013 (UTC)

Thanks Mallexicon for great effort on the new Mechanisms of action section. Why have you omitted 4 of the sub-sections above? The Placebo effect has very wide support and incorporates tertiary evidence ie meta-analyses. Dr Langevin's work on fascia, although citing a primary source, is very widely supported, has been cited many hundreds of times and is included in a number of secondary sources elsewhere in the article. Dr Pomeranz's work on monoamimes also has much support as does Diffuse Noxious Inhibitory controls. Some of the neural deactivation work is also supported by secondary sources. Either way, given that this whole section talks about research and hypotheses, there is a good case for including primary sources here. If you go to Misplaced Pages's Antidepressants page you will see that every reference in the Mechanism of action section is supported only by primary reference sources. Does the acupuncture postulated mechanisms of action section require a higher level of evidence than that of antidepressants for inclusion? There is a good case for the whole section - as above - with all 7 sub-headings to be part of the article. I'd be interested to hear from Herbxue and Puhlaa on this.--Tzores (talk) 04:06, 14 June 2013 (UTC)

Well, you have a point about the primary sources... Why don't you insert the remaining sections into the article and see what the other editors think? Would be interesting to see what the sceptics have to say... --Mallexikon (talk) 13:08, 15 June 2013 (UTC)

Have made this a separate section to the Questionable validity of the acupuncture model section. I will work on finding more secondary sources and will then insert remaining into the Possible Mechanism of Action section.--Tzores (talk) 01:19, 21 June 2013 (UTC)

As suggested by Mallexicon, I have now incorporated this into the article to reflect current scientific thinking. Most of the sources are secondary/tertiary, but have included some primary sources too as the section is about theory. This is in line with the Antidepressants article's Mechanism section (I think originally suggested as a model for this by Herbxue??) which only has primary sources. For the sceptics (including me, although I have maintained NPOV), top of the list is Placebo which wasn't much in the article before, but has the most scientific community support! I'd appreciate some assistance please - the ref by Vickers has been cited elsewhere in the article and needs to be merged; also, there is a Diffuse Noxious Inhibitory Control Misplaced Pages article, but I can't seem to link to it - thanks--Tzores (talk) 23:42, 25 June 2013 (UTC)

Recent edit

I've restored related, non-medical content since there was no consensus for its removal as per Talk:Acupuncture#Acupuncture_usage_in_the_US_military_and_other_military_forces -A1candidate (talk) 13:26, 15 June 2013 (UTC)

Well as I wrote in my edit summary, there was consensus about this - in the Talk:Acupuncture#Suggestion: Current research and recommendations section. Cheers, --Mallexikon (talk) 07:40, 17 June 2013 (UTC)

I believe you are clearly misinterpreting the entire discussion. It was about medical claims/recommendations. As for its usage, I think Herbxue seems to agree that it should be included, see Talk:Acupuncture#Acupuncture_usage_in_the_US_military_and_other_military_forces. Lets hope this doesn't drag into an edit war -A1candidate (talk) 07:44, 17 June 2013 (UTC)

"Clearly misinterpreting"... hmmm. The part of the discussion I'm referring to says this:

"@Herbxue: I don't mind stating what agencies "tasked with making health care recommendations" have to say about acupuncture... The armed forces of the US and Germany hardly fall under that category, though. --Mallexikon (talk) 08:46, 29 May 2013 (UTC)

Ok thanks, I thought you meant all the proposed sources were irrelevant.Herbxue (talk) 14:13, 29 May 2013 (UTC)

I would agree with Mallexikon here, the recommendations of the WHO are clearly relevant as a body of medical experts while the opinions of the armed forces of some few (select) countries are hardly relevant for the article...()... Greetings --hroest 11:49, 29 May 2013 (UTC)"

As would I. I can't see any relevance to this article. Dominus Vobisdu (talk) 08:38, 17 June 2013 (UTC)

I'm sorry if I misinterpreted this as consensus to my position on Herbxue's side if there actually is none... I think hroest was pretty non-ambiguous, though. --Mallexikon (talk) 08:21, 17 June 2013 (UTC)

Changes to article's lede

I've added the following statement to reflect current research and scientific consensus on the topic "Currently, the official MEDLINE database compiled by the U.S. National Library of Medicine acknowledges that researchers do not fully understand how acupuncture works." and made some other minor edits. I dont think these edits should be controversial, but if there is disagreement lets discuss it here -A1candidate (talk) 13:31, 15 June 2013 (UTC)

"Acupuncture". NLM. Retrieved 31 May 2013.

RfC: Should acupuncture in the military be included?

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Acupuncture in the military

Usage in the United States military According to The Washington Times, the U.S. Military's first encounter with acupuncture occurred during the Vietnam War, when an Army surgeon wrote in the 1967 edition of Military Medicine magazine about local physicians who were allowed to practice at a U.S. Army surgical hospital and administered acupuncture to Vietnamese patients. In 1995, Dr. Richard Niemtzow, a retired U.S. Air Force colonel who had earlier practiced medicine as a radiation oncologist, began offering acupuncture to military personnel stationed at the McGuire Air Force Base in New Jersey. A few years later, Niemtzow became the first full-time military medical acupuncturist for the U.S. Navy. In 2009, the U.S. Air Force set up the Air Force Acupuncture Center at the Joint Base Andrews in Maryland to practice and teach "battlefield acupuncture" to physicians and other medical personal. That year, the Naval Medical Center San Diego reported that its pain management clinic had provided acupuncture to more than 2,600 beneficiaries. As of 2012, over a hundred medical professionals in the U.S. Air Force have been trained to use acupuncture techniques. While the pratice of acupuncture was mostly limited to the U.S. Air Force, it soon spread to other departments of the U.S. Military including the U.S. Navy and the U.S. Army. In late 2012, the Office of the Secretary of Defense officially approved a visit by U.S. military physicians to the Beijing University of Chinese Medicine in order to strengthen Sino-American military relations and to "exchange acupuncture information". Usage in other military forces Since 2010, acupuncture has been practised by the German Bundeswehr in several military hospitals. In the People's Republic of China, acupuncture has been used by the People's Liberation Army to aid in the treatment of battlefield injuries.

Would the section above, regarding acupuncture in the military, be a desirable addition? -A1candidate (talk) 08:39, 17 June 2013 (UTC)

Threaded discussion

• Oppose. What the armed forces or the postal services think about acupuncture is not relevant here. --Mallexikon (talk) 10:15, 17 June 2013 (UTC)
• Oppose: Irrelevant to the topic of this article and adds nothing to understanding the topic of this article. The fact that a scattering of military forces have tried out accupuncture is of trivial significance. Essentially OR based on Google trawling of non-MEDRS-compliant popular news articles. Dominus Vobisdu (talk) 17:40, 17 June 2013 (UTC)
• Oppose 1. Irrelevant. 2. synthesis of sources to advance a point. 3. Most of the sources are primary, IRWolfie- (talk) 00:25, 18 June 2013 (UTC)
• Oppose - I recommend a separate article on "Battlefield Acupuncture" (this is notable enough) which can be linked to from a brief mention of this somewhere in the acupuncture article. The main issue for me is it is too much about the U.S. military and not enough of a broad-based section on the prevalence of acupuncture use. I would support a section on prevalence to address the "mainstream or fringe" question. Herbxue (talk) 20:52, 21 June 2013 (UTC)
• Oppose as per the points above. Samwalton9 (talk) 14:18, 22 June 2013 (UTC)
• Oppose following Herbxue's reasons. Rex (talk) 20:46, 26 June 2013 (UTC)
• Comment: The article Usage of acupuncture in the military was created by A1candidate (talk · contribs) and I have nominated it for possible deletion: Misplaced Pages:Articles for deletion/Usage of acupuncture in the military.-- Brainy J ~✿~ (talk) 13:36, 28 June 2013 (UTC)

Medical procedure?

I wouldn't call its affiliated procedures (moxibustion, cupping etc.) medical, but acupuncture itself probably is... (it's also listed in WP's Medical procedure article). If no one objects I'd change the lead sentence accordingly. Cheers, --Mallexikon (talk) 06:09, 23 June 2013 (UTC)

I would object. While accupuncture is sometimes used by physicians, it is usually practiced by quacks, much like moxibustion and cupping. Calling the procedure medical would legitimize the practices of these quacks. Furthermore, the evidence for the effectiveness of accupuncture is limited and equivocal, and it still has not entered the medical mainstream. It is still more alternative medicine than medicine. Dominus Vobisdu (talk) 07:27, 23 June 2013 (UTC)

Push POV much Dominus? I don't care whether you call it a medical procedure or not, but cupping and moxa are typically practiced by professional acupuncturists, the Chinese term for acupuncture includes moxa (zhenjiu 针灸). I don't see a reason to differentiate, unless you are pointing out that MD's occasionally use acupuncture as a stand-alone therapy, separate from theory and associated techniques?Herbxue (talk) 19:41, 23 June 2013 (UTC)

Were you addressing me or Mallexikon? If me, you seem to have misread my comment. Yes, I do mean that "MD's occasionally use acupuncture as a stand-alone therapy, separate from theory and associated techniques". Nevertheless, it remains more alternative medicine that mainstream evidenced based medicine. Dominus Vobisdu (talk) 20:24, 23 June 2013 (UTC)

I was addressing Mallexikon. The article title "Acupuncture" could have very narrow or very broad meanings and I think different editors assume different things. Broad meaning would have acupuncture refer to the whole system of healing of which it is (usually) a part (which also could narrowly refer to "TCM" or broadly to Traditional East Asian Medicine) or narrowly to the insertion of needles into the body for therapeutic effect. I only mention this to explain my post above about "zhenjiu" including more than just needle insertion.Herbxue (talk) 21:00, 23 June 2013 (UTC)

So how about adding the word medical to procedures in the lede sentence? I kinda would, DV is against it... else opinions? --Mallexikon (talk) 02:13, 25 June 2013 (UTC)

I support using the term medical procedure. "Medicine" is not a term that exclusively applies to contemporary biomedicine, which itself is not exclusively evidence-based.Herbxue (talk) 03:32, 25 June 2013 (UTC)

Unqualified, "medicine" does indeed strongly imply modern medicine, and does exclude alternative "medicine" and traditional Chinese "medicine". We already have in the next sentence of the lede that the procedure is used in traditional Chinese "medicine", and shortly after that put its use in modern medicine in proper context. Adding "medical" to the first sentence of the lede is very misleading and would violate WP:GEVAL. Dominus Vobisdu (talk) 15:08, 25 June 2013 (UTC)

I think you go too far. "Medicine" is the diagnosis and treatment of disease. The idea that the word medicine is owned by conventional modern medicine is an opinion, not a fact. Herbxue (talk) 15:27, 25 June 2013 (UTC)

It is a very widespread opinion, and a very reasonable assumption. We use words according to common usage, and common usage is that medicne refers to modern medicine, and not alternative "medicine". See our article on Medicine. Quackery can call itself "medicine" to fool the gullible, but that does not make it medicine, as the article on Alternative medicine makes clear. The lede is fine as it is, and the proposed change would violate our policies. Dominus Vobisdu (talk) 15:56, 25 June 2013 (UTC)

If your point were stronger you wouldn't need ad hominem attacks. The definition of the word does not exclude practices outside of the mainstream. Even if it did, the argument presumes that no mainstream MD's use acupuncture, which is also not true.Herbxue (talk) 21:08, 25 June 2013 (UTC)

Again, you're confused. Read my post further up. And the fact that mainstream MD's occasionally use acupunture is, as I said, already mentioned in the lede in the appropriate context. You seem to misunderstand what an "ad hominem" is. I see none. Dominus Vobisdu (talk) 21:18, 25 June 2013 (UTC)

The question at hand - "Is acupuncture a medical procedure" - is not answered by your opinion that it is practiced by "quacks", you are labeling people with an insult in order to argue that the word "medical" is inappropriate. That is what I am calling ad hominem, acknowledging it is a group rather than a person you are attacking. I personally think many docs who take gifts in exchange for promoting certain medications are quacks and dangerous opportunists, but that does not mean that what they are doing is not an attempt at practicing medicine. The opinion on the group is irrelevant to the question at hand. Herbxue (talk) 21:44, 25 June 2013 (UTC)

The reason I'd tend to call it a medical procedure is the fact that we have evidence of efficacy (at least for some conditions). This would also be the reason why I'd oppose calling it "quackery". --Mallexikon (talk) 01:54, 26 June 2013 (UTC)

I'd like to see the sources we'd use to call it a "medical procedure". TippyGoomba (talk) 03:18, 26 June 2013 (UTC)

And high quality secondary WP:MEDRS sources only that confirm that it is widely considered a medical procedure within the medical community. Otherwise, it's OR or UNDUE. Dominus Vobisdu (talk) 19:44, 26 June 2013 (UTC)

I can't find any highly cited reliable sources referring to acupuncture as a medical procedure, these for example do not:

• K Streitberger, J Kleinhenz, MD. Introducing a placebo needle into acupuncture research. The Lancet, Volume 352, Issue 9125, 1 August 1998, Pages 364–365,
• Ji-Sheng Han. Acupuncture: neuropeptide release produced by electrical stimulation of different frequencies. Trends in Neurosciences, Volume 26, Issue 1, January 2003, Pages 17–22,
• NIN Consensus Development Panel on Acupuncture. Acupuncture. JAMA. 1998;280(17):1518-1524,
• Ted J. Kaptchuk; Acupuncture: Theory, Efficacy, and Practice. Annals of Internal Medicine. 2002 Mar;136(5):374-383.

All of which have hundreds of citations each. (Sorry for the formatting) Samwalton9 (talk) 20:10, 26 June 2013 (UTC)

"There is no alternative medicine. There is only scientifically proven, evidence-based medicine supported by solid data or unproven medicine, for which scientific evidence is lacking. Whether a therapeutic practice is 'Eastern' or 'Western,' is unconventional or mainstream, or involves mind-body techniques or molecular genetics is largely irrelevant except for historical purposes and cultural interest. As believers in science and evidence, we must focus on fundamental issues - namely, the patient, the target disease or condition, the proposed or practiced treatment, and the need for convincing data on safety and therapeutic efficacy." - Fontanarosa P.B., and Lundberg G.D. "Alternative medicine meets science" JAMA. 1998; 280: 1618-1619. ... I'd like to point out that we have very good evidence for efficacy of acupuncture. Cheers, --Mallexikon (talk) 01:54, 27 June 2013 (UTC)

We're not exploring the evidence for acupuncture at the moment, we're talking about calling it a medical procedure. To do so, we need sources. Do you have any? Or are you now dropping your proposal to state that acupuncture is a medical procedure? TippyGoomba (talk)

Well, we have plenty of sources calling it alternative medicine... do you understand what I'm getting at? --Mallexikon (talk) 03:06, 27 June 2013 (UTC)

Draft a sentence or two complete with sources and we'll take a look. I predict we'll end up in WP:OR or WP:SYNTH land but I'm always ready to be surprised. TippyGoomba (talk) 03:29, 27 June 2013 (UTC)

As you wish... --Mallexikon (talk) 04:20, 27 June 2013 (UTC)

I wasn't suggesting you edit the article, clearly it would get reverted. I just wanted something concrete to discuss.

Two of the three references you give fail WP:RS. But this passes the smell test. It states Acupuncture is one of the oldest, most commonly used medical procedures in the world which it sources to nccam.nih.gov, which fails WP:RS. TippyGoomba (talk) 04:44, 27 June 2013 (UTC)

Careful with the quick reverts, man... this was sourced material, and not everybody is a fan of WP:BRD (luckily, I am)... anyway, the fact that Stanford sources an NIH statement means that they endorse it. So their credibility backs it up. Which makes this a reliable source. Cheers, --Mallexikon (talk) 04:58, 27 June 2013 (UTC)

Again, we're not looking for a single source or sporadic sources that call acupuncture a "medical procedue", but for a good source that acupuncture is WIDELY considered a medical procedure by the majority of the medical community. If it's just a minority position, that would violate WP:UNDUE. And that source has to be a reliable secondary source that conforms to WP:MEDRS, preferably an academically reviewed review article or book. Dominus Vobisdu (talk) 06:51, 27 June 2013 (UTC)

Well I don't know what you are looking for but your we certainly doesn't include me (so who are you talking about?)... And I'm not quite sure what you mean with secondary source when what we talk about are matters of terminology...? I'm also not quite sure why you are evoking WP:UNDUE since we're not dealing with a theory... But I can see where your unease is coming from... so for consensus' sake, how about calling it "alternative medical procedure" then? --Mallexikon (talk) 09:10, 27 June 2013 (UTC)

A secondary source would be something like a book or systematic review. Do you have a source for your new suggestion? TippyGoomba (talk) 15:20, 27 June 2013 (UTC)

The "we" of Dominus also does not include me. This seems like a pretty simple issue to me - do you also need a systematic review of RCT's to state that acupuncture is a "procedure"? No, its just a description not a medical claim of efficacy or safety. Really, its over the top what you are asking for to justify a simple and accurate description, and I think Mallexikon has satisfied your need for a source.Herbxue (talk) 15:53, 27 June 2013 (UTC)

Not even close. Sorry, but what you're proposing is OR and UNDUE. Ain't gonna fly. Dominus Vobisdu (talk) 00:38, 28 June 2013 (UTC)

I'm not proposing the edit, I'm supporting it - creating consensus.Herbxue (talk) 02:52, 28 June 2013 (UTC)

We don't count votes, we discuss, see WP:CON. So far your contribution the discussion has not even demonstrated an understanding of the objections raised, let alone addressed them. You are not supporting the edit, you are cheering for it. TippyGoomba (talk) 03:42, 28 June 2013 (UTC)

Tell me what I don't understand, please. I think my statements have been quite reasonable so I request that you assume good faith and address the content rather than make assumptions about me.Herbxue (talk) 05:24, 28 June 2013 (UTC)

My apologies, I assumed you'd read the entire thread. Essentially, we have no sources which support "acupuncture is a medical procedure" and to quote Vobisdu: we're not looking for a single source or sporadic sources that call acupuncture a "medical procedue", but for a good source that acupuncture is WIDELY considered a medical procedure. Mallexikon has since withdrawn his initial suggestion (I think) and is now suggesting "alternative medical procedure", sources pending. TippyGoomba (talk) 05:46, 28 June 2013 (UTC)

I don't have a lot of time right now, so I'll return to this discussion later... just wanted to point out that we've had quite a few editors banned from this article because of frequent ad-hominems... And thanks, Herbxue, for keeping your cool. Cheers, --Mallexikon (talk) 07:36, 28 June 2013 (UTC)

There was no ad hominem. Tippy was perfectly correct in pointing out that Herbxue has not addressed the policy-based objections raised and has apparently misunderstood what consensus means on WP. Dominus Vobisdu (talk) 07:42, 28 June 2013 (UTC)

@TippyGoomba: Even that proposal would be redundant, because of the next sentence in the lede. It already states that accupuncture is part of traditional Chinese medicine.

@Herbxue: What you are not understanding is the policies that are being cited in this argument, especially: WP:RS, WP:MEDRS, WP:NOR, WP:NPOV and WP:FRINGE. The bar is set VERY high on all medicine-related material, especially fringe-related material, here on WP. The sources have to be impeccable. Dominus Vobisdu (talk) 07:42, 28 June 2013 (UTC)

DV, I guess what you are not really understanding is the meaning of Misplaced Pages:No personal attacks. I suggest you read it again and change your tone. We're all very happy with discussing content here, but these ad-hominems gotta stop. Seriously. --Mallexikon (talk) 01:09, 30 June 2013 (UTC)

Are you still suggesting an edit? TippyGoomba (talk) 03:06, 30 June 2013 (UTC)

Yes. My suggestion is to change the first lede sentence to "Acupuncture is a collection of alternative medical procedures ..." Sources would be this Clinical UM Guideline, the NHS, the NIH, and the Stanford source we already discussed. Cheers, --Mallexikon (talk) 04:23, 30 June 2013 (UTC)

Not in sources. TippyGoomba (talk) 05:08, 30 June 2013 (UTC)

Quoting: 1.) "Acupuncture is one of the oldest, most commonly used medical procedures in the world..." 2.) "Acupuncture is a form of ancient Chinese medicine ... It is a complementary or alternative medicine.." 3.) "Acupuncture is one of the oldest and most commonly used forms of traditional medicine... " --Mallexikon (talk) 05:16, 30 June 2013 (UTC)

Looks good to me, clearly supported by the sources. I think TIppy is saying the "collection of...procedures" is not in the sources (correct me if I'm wrong). The statement in Mallexikon's proposed edit is accurate because acupuncturists typically employ at least several different "procedures" including cupping, gua sha, moxa, electrostimulation, etc.Herbxue (talk) 15:21, 30 June 2013 (UTC)

Mallexikon made three proposals, which are you referring to? IRWolfie- (talk) 15:34, 30 June 2013 (UTC)

No, that's a misunderstanding. I made an initial proposal and then altered it to this: change the first lede sentence to "Acupuncture is a collection of alternative medical procedures ..." Sources would be this Clinical UM Guideline, the NHS, the NIH, and the Stanford source we already discussed. Cheers, --Mallexikon (talk) 05:33, 1 July 2013 (UTC)

Nothing about "alternative medical procedures" in those sources. Furthermore, the statement is ambiguous. It has the potential to be read as "alternative (medical procedures)" as opposed to "procedures in (alternative medicine)". TippyGoomba (talk) 07:26, 1 July 2013 (UTC)

True... but we could avoid the ambiguity by wikilinking: alternative medical procedure. --Mallexikon (talk) 08:22, 1 July 2013 (UTC)

I take the lack of responses as a quiet agreement... About that "nothing about alternative medical procedures in the sources": no, not literally - that would be plagiarism. But the sources clearly say that acupuncture is alternative/traditional medicine, and that it is a procedure (one could argue that these two conclusions actually amount to common sense, but it's always nice to have sources anyway). Alternative medical procedure therefore is proper close paraphrasing. Cheers, --Mallexikon (talk) 01:30, 2 July 2013 (UTC)

No, there is still no consensus. What you are describing is classic WP:SYNTH. Furthermore, it adds nothing to the article that is not already in the second sentence. Your reading of plagarism is not correct, either. Dominus Vobisdu (talk) 06:50, 2 July 2013 (UTC)

Are you saying that going from "alternative medicine" to "alternative medical" is synthesis?Herbxue (talk) 14:47, 2 July 2013 (UTC)

How you came to that conclusion based on what I wrote above is beyond me. Dominus Vobisdu (talk) 15:01, 2 July 2013 (UTC)

Man, can't even ask you a simple question. I did not come to a conclusion, I asked you a question. Mallexikon presented sources calling acupuncture "alternative medicine", citing them to propose an edit calling it an "alternative medical procedure", then you said it is "classic synth" - now, I'm asking you, what is the synthesis you are referring to?Herbxue (talk) 15:50, 2 July 2013 (UTC)

See Mallexion's post immediately before mine. Then see Tippy Goomba's post last post to which Mallexion was replying. Cobbling something together that does not exist in the sources is the definition of WP:SYNTH. Furthermore, it's still superfluous. And ambiguous. Dominus Vobisdu (talk) 16:05, 2 July 2013 (UTC)

What you are saying is simply not true. The sources use the terms "alternative medicine" and "traditional medicine". Changing this to "alternative medical" is close paraphrasing, and where you see WP:SYNTH totally eludes me. Your concern about ambiguity has been addressed as well - we'll avoid it by using a wikilink... I got the feeling you just completely refuse to play ball here - you call for reliable sources, and as soon as I present them it's something else you don't like. Now you come up with a completely different issue, saying my proposed change was superfluous. I guess it's better to call for an outside opinion, so I'll take this to the DR/N (Talk:Acupuncture#Medical procedure?). Cheers, --Mallexikon (talk) 03:29, 3 July 2013 (UTC)

I've been saying the statement is redundant for over a week now, which you would know if you had taken the time to read my posts. It's always been one of my main objections. And I'm tired of this deadhorse discussion. I've been patient and considered your arguements and answered them fully. I remain unconvinced by them. As far as I'm concerned, there is no point in further discussion. Drop the stick already. Dominus Vobisdu (talk) 04:04, 3 July 2013 (UTC)

Unconstructive behaviour. Better to take this somewhere else. --Mallexikon (talk) 04:46, 3 July 2013 (UTC)

Medical procedure, part II

Since DR/N declined to deliver a judgement whether the sources I've contributed so far do or do not support the change I intended: let's start from scratch. I propose to change the lede sentence to: "Acupuncture is a medical technique involving..." My sources are:

1. Encyclopedia Britannica ("acupuncture, ancient Chinese medical technique for...")
2. The Skeptic's dictionary ("Acupuncture is a medical technique...")
3. Merriam-Webster dictionary ("Medical technique in which needles are inserted into the skin...")
4. Random House dictionary ("a Chinese medical practice or procedure...")
5. This Clinical UM Guideline & Stanford Hospital ("Acupuncture is one of the oldest, most commonly used medical procedures in the world...")

And no, trying to argue that "medical procedure" does not automatically imply "medical technique" will not fly. Cheers, --Mallexikon (talk) 10:43, 4 July 2013 (UTC)

If you're abandoning the WP:DR/N, please let them know. I don't think it's appropriate to start a separate but related discussion outside their framework while you have a case open there. TippyGoomba (talk) 15:56, 4 July 2013 (UTC)

I haven't been following this particular discussion, but this is a no brainer. Of course it's a medical procedure. It could also be qualified as a TCM medical procedure. Here are the current two first sentences, with TCM mentioned earlier:

• Acupuncture is a collection of traditional Chinese medicine (TCM) procedures involving penetration of the skin with needles in order to stimulate certain points on the body. In its classical form it is a characteristic component of TCM, and one of the oldest healing practices in the world.

That could even be shortened to remove superfluous content that really says nothing:

• Acupuncture is a collection of traditional Chinese medical (TCM) procedures involving penetration of the skin with needles in order to stimulate certain points on the body, and is one of the oldest healing practices in the world.

How's that? Note that we're already calling it a "healing practice," which is far more dubious than just calling it a TCM procedure. -- Brangifer (talk) 16:57, 4 July 2013 (UTC)

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