What is acupuncture and is there any benefit from it
Acupuncture is one of the branches of alternative medicine. She is often criticized by adherents of an evidence-based approach, in which therapeutic and prophylactic measures should be applied only after their effectiveness has been confirmed by scientific research. Nevertheless, the demand for the services of masters of acupuncture has been growing in recent years, scientists at leading universities like Yale are urged not to abandon therapy just because its mechanism has not yet been fully studied, and everyone has heard about the anesthetic effect of needles from people with arthritis. older relatives. We decided to find out, as far as possible, the nature of acupuncture, consulted with supporters and critics of the direction and found out whether it is worth trying this technique at all.
The inhabitant of the post-Soviet space is perhaps more familiar with the term "reflexology" - the effect on certain areas of the body with fingers, needles and other objects. What is acupuncture, acupuncture alone - extensive in practice methods that differ in instruments and method of influence on active points of the body. In accordance with the philosophy of Oriental medicine (and without philosophy, it is nowhere), these points are not located chaotically, but along the meridian channels through which the vital energy of qi flows. Qi is one of the fundamental concepts in Chinese culture and alternative medicine, which migrated from there, for example, to the new age: adherents of Chinese philosophy believe that it permeates not only the human body, but the whole world. In turn, active points are supposedly located on the meridian channels at different depths, through each of which you can reach the qi energy. Practitioners of reflex-theoreticians believe that the correct effect on one or other active points is able to establish the flow of human qi and, as a result, save it from almost all health problems.
Specialists in reflexology, as well as supporters of traditional medicine, view the whole body as an interconnected system and proceed from the considerations that it is also necessary to approach its treatment in a complex way. A competent acupuncturist seeks to eliminate not only the symptoms of the disease, because it contradicts the holistic approach of acupuncture: if you do not look at the state of the whole body, the correction of one malfunction can provoke the occurrence of another.
The range of problems that acupuncture promises to solve is great, but not infinite.
For a patient, each procedure is not much different from the previous one: before the session, the doctor performs a diagnosis, arranges sterile needles in the right quantity and order in accordance with it (if necessary, it can additionally warm up or massage individual points) and leaves it alone for twenty to thirty minutes. The peculiarity of acupuncture sessions is that each next one is slightly more painful than the previous one: this is explained by the fact that the nerve conduction gradually increases. So by sensitivity to injections for the third or fourth session, you can understand your susceptibility to them.
The range of problems that acupuncture promises to solve is great, but not infinite. Igor Kim, a resuscitation and neurologist, said that acupuncture treats well the problems of the musculoskeletal system, problems of the gastrointestinal tract and perfectly normalizes the nervous system. "Most patients come with problems of the spine, as this is traditionally what is associated with acupuncture. But sometimes the process solves a few more side effects. For example, a woman came with a spine problem typical of a sedentary lifestyle: muscles are constrained, nerves are clamped, spinal discs they put pressure on each other. As a result of several sessions, her nervous system also calmed down, she began to react less emotionally to working problems, "Kim shares her experience. However, he acknowledges that acupuncture should not be considered a panacea, but an alternative or complementary method of treatment. It cannot be a substitute for antibiotics and abdominal operations, if they are shown. "Acupuncture can not cure ankylosing spondylitis and asthma, but can significantly improve the quality of life for these diseases: reduce pain, improve the quality of breathing," explains Kim.
According to him, acupuncture can be combined with traditional treatment: for example, for serious arthritic problems, when surgery is indicated, with the help of acupuncture, pain can be significantly reduced before and after surgery. With some types of hernia, acupuncture can be a substitute for surgical intervention, but no sensible acupuncturist will undertake to treat kidney stones and gall bladder - this is the task of traditional surgery. Endocrinologist Nikita Taller explains that acupuncture is often used by nutritional centers, but it is always an addition to diet therapy and physical therapy. The use of reflexology in sports medicine is a special topic: everything is now used "from genetic engineering to alchemy".
According to Taller, theoretically, acupuncture is fairly safe if it is performed in a specialized institution with sterile needles and to a regulated depth of penetration, and not in the underground office of Chinese medicine. "In my field of activity (clinical endocrinology), reflexotherapy is practically not used, domestic and foreign treatment algorithms and guidelines of the leading associations do not indicate acupuncture among the recommended treatment methods." He also says that acupuncture for a long time, but not too successfully tried to use for pain relief in patients with complications of diabetes (diabetic polyneuropathy). However, this pain is not always relieved even by narcotic painkillers and anticonvulsants.
The efficacy of acupuncture is often explained by the placebo effect.
Proponents of acupuncture claim that side effects are not peculiar to it. The only contraindication for her (except for such damage to the skin, in which contact with him is impossible) are cancer: it is believed that intervention in the body and stimulating the immune system in this case is unacceptable. Drug treatment, in turn, often causes allergies and affects not only diseased organs and systems, but also healthy ones; in the case of a correctly performed acupuncture, this, according to her advocates, is impossible.
However, adherents of an evidence-based approach are condescending or even extremely skeptical of acupuncture. Taller confirms: “With evidence-based reflexology, there are problems. Most of the studies were conducted in China, which is absolutely logical - this is one of the wealth of the nation. Studies that confirmed the effectiveness were either conducted on an extremely small and fairly specific group of patients, or had other fundamental errors.” . As with other methods of alternative medicine, advocates of an evidence-based approach tend to explain the efficacy of acupuncture solely by the placebo effect. To check, they invented to compare imitation of acupuncture - while the needles are either not inserted at all, or in a chaotic manner, or to an insufficient depth - with this procedure. Some researchers argue that the effect of such fake acupuncture is almost commensurate with actual acupuncture.
Edzard Ernst, a tireless researcher of alternative medicine (he has been studying it for more than twenty years, now in emeritus status) wrote a book based on the results of his work. Its main conclusions are as follows: the ideas with which alternative medicine operates are often implausible and must be taken critically; many of its possibilities have not been proven, and a rather large percentage of them should be refuted; only a small number of alternative therapies do more good than harm. In addition, Ernst not without causality notices that all the members of the team with which he had previously conducted research approached the matter biasedly and tried to prove their point of view (they believed in alternative medicine), and not pull the truth into the light. Such an ardent opposition to the group is a bit like a position about a white coat, but Ernst has a trump card - his last meta-analysis (that is, a review) of many acupuncture studies from 2000 to 2010, jointly with his Chinese colleagues. Even a quick glance at the tables makes it clear that acupuncture does not always cope with the elimination of pain (this is one of the main reasons why patients address it), and it still has side effects (mainly infectious diseases and tissue damage that almost always completely cured).
Principles of acupuncture are used in physiotherapy procedures.
Taller argues that the meta-analyzes for the question about the effectiveness of acupuncture do not clearly answer: for example, in relation to the treatment of hypertension, according to the 2015 review, a slight positive effect was shown in combination with drugs to reduce pressure, but the safety of monotherapy and determination of indications for use left without an adequate response. "It is curious that almost every second review or meta-analysis in the largest database on medicine MEDLINE ends with approximately the same thought: at the moment there is no or insufficient evidence that requires rigorously developed and regulated research on the topic."
According to him, American and European researchers are even more skeptical, since their results are comparable to the placebo effect (although the average person may rightly see that they simply do not have the Chinese “correct” acupuncture technique). The Cochrane Review of 2009 is well known, in which, of the many states studied, a statistically significant effect was achieved only when two symptoms were relieved: nausea and dizziness. Subsequently, placebo-exceeding effects were shown in relation to relieving some pain syndromes and treating non-severe psychosomatic disorders, but they were inferior to regulated (surgical or medical) treatment methods. The principles of acupuncture are used in other physiotherapeutic procedures, such as electrostimulation.
In Russia, however, a somewhat special attitude to such therapeutic methods is: “In our country, the term„ traditional medicine “usually implies traditional methods of treatment, whereas in the English-language literature the term„ alternative medicine “is used. To some extent, this reflects the approach to the problem : in our country, such treatment methods are perceived as basic, "natural", in Europe and the USA - as requiring proof of effectiveness. Unlike many other areas of alternative medicine, acupuncture in Do some form of trying to apply and in clinical medicine So, even in the Soviet, and later in the Russian medical universities taught a course of acupuncture in the study of physiotherapy treatments, and later was approved and a specialty -. physician-reflexologist, "- says Taller.
The definitive conclusion, unfortunately, is not yet available. Acupuncture is gaining popularity, although it can not boast a convincing evidence base - at least in the format that would satisfy the supporters of traditional medicine. Its acclimatization and an inseparable philosophical component make it difficult: in order for acupuncture to work, the specialist and - ideally - the patient should understand his whole holistic idea, which is far from appealing to everyone. Ultimately, the same principle works as in traditional medicine: the more data the better, the second opinion is never superfluous, and the quality of procedures directly depends not only on the doctor’s enlightenment, but also on his practical skills.
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