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Top 10 Misconception of Chinese Medicine (Part 1)

by Allen Tsaur, on 6/07/2017

1. Acupuncture hurts!

This is the most common thing brought up to me in regard to acupuncture, for both Chinese and Westerners alike. For granted, the idea of someone sticking a needle in you sounds quite alarmingly uncomfortable.

For the Chinese people, they are not quite wrong. Based on archaeological findings, the acupuncture needles were first made with bone (7000-8000 BC). Later, as men learned to work with materials, stone (2000 BC), bronze (1000 BC) and wrought iron needles appeared. Later, silver and golden needles appeared around 100 BC. Due to their oligodynamic (antiseptic) effect and corrosion resistance, they remained as the material of choice for needles for the next two thousand years; however, these remain as imperfect materials. Pure gold is soft and pure silver is brittle. If they were made into thin gauges, then they would be unable to penetrate the skin. or worse, they would easily break after being  inserted. Thus, for safety reasons, the needles were generally made in thick gauges (about 0.6-0.8 mm in diameter) and they did hurt. 

 

Most likely, in reality, wrought iron was the most common material used for actual practice due to their affordable cost; yet, wrought iron is brittle and prone to rusting, which needs to be constantly and properly maintained. Thus it was almost always in thicker gauge as well for safety reasons.

In the contemporary age, with the availability of stainless steel, which is not only hard (which allows an easier/less painful penetration) but also tough (which resists breaking) and highly resistant to corrosion. Its cheap cost also allows for disposable needles for the first time. With this advancement, needle breaks have become extraordinarily rare. Acupuncture needles are likewise made into ever thinner gauges, In Wind Lake Acupuncture, disposable, sterile needles in 0.16-0.22 mm gauge are generally used, which is a fraction of the traditional needles and about the width of two threads of human hair, When receiving acupuncture with the modern needles, the general sensation is a light prick or a mosquito bite at the skin level. It’s nothing like getting a shot or giving blood. 

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2. Acupuncture is un-scientific and it is just superstition

This in my experience has become a you-say vs. I-say conversation. With our emphasis in science and our medical knowledge based anatomical science, it is hard to visualize energetic pathways and Qi - which are the foundations upon which acupuncture develops. To make the matter worse, here in the States, acupuncture is a young profession that barely started, we still have not generated enough research capitals to support the many claims we have made. Many research we publish are either deemed flawed due to the therapy's innate incompatibility with the explanatory, blinded randomized trials with its holistic approach.

Yet at the same time, I beg, for the scientific-minded to look into empirical evidences. If acupuncture does not work, then no one should get better after acupuncture treatments. If that were true, then could the multitudes of writings and medical case studies be all fraudulent? As long there is a person actually receive benefits from a treatment, then it is an observable fact that should be taken note of, whether not the underlying mechanism is proven.

If acupuncture were just superstition and placebo effect, then it would fail to answer why the profession is slowly becoming recognized and supported with mounting clinical evidences. Even medical insurances in the US started to cover it. In addition, acupuncture research is continually being funded by the National Institute of Health (NIH) and is recognized by the NIH and World Health Organization (WHO). WHO specifically provide a list of treatable diseases by acupuncture which can be found in this link.

On a side note, Chinese medical practitioners have long separated themselves from the shamanistic medicine. This can even be found in the evolution of the Chinese character for medicine (醫 yi1):

 is original character for medicine, with a radical of 巫, shaman/shamanism. This character was the norm in the early Zhou dynasty (1000-700 BC). It is however rarely seen in the contemporary age, except in shamanistic or Taoist rituals.

 is the later/contemporary character for medicine, with a radical of 酉, which means wine, tincture, fermented substance. This is the character for medicine today. This indicates the move of medicine from shamanistic medicine to (herbal) tincture medicine sometime in the past, likely in the Spring-Autumn or Warring States eras (700-200 BC).

In 史記 Records of the Grand Historian (94 BC), Bian Chue, one of the greatest medical practitioners in Chinese history, is famously recorded to have six groups of people that he would refuse to treat. One of them was, "those who have faith in the shamans but not the medical practitioners." If Chinese medicine or acupuncture were mere superstition, then what was it that they were trying to change more than two millennia ago? 

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3. It’s been used for thousands of years, so it must work

This is a claim that many practitioners use, but I must address this claim. 

Historically speaking, we are not really practicing what people were doing thousands of years ago, in fact, we are not even doing what people did 100-200 years ago.

  1. First of all, we no longer use non-disposable, thick, gold/silver needles.

  2. The classical acupuncture lineages emphasized treating on the channel systems with elaborated needle techniques and tools. This practice have largely fallen into obscurity. The modern practice mostly emphasizes on prescription of points, and in many instance disregard the channels.

  3. Comparing to acupuncture, herbal medicine is a field that constantly evolve as medical practitioners obtained new plant species and domesticated them for medical purposes. Today's herbal processing is very different from the traditional processing, and at times may cause unintended effect if one were not careful.

  4. Herbal medicine, likewise, emphasizes in functional anatomy such as 6-stages, 4-levels, 3-burners, and 5-transportation-6-qi systems. Except in a few medical lineages, these are rarely discussed in today's institution education and are usually treated as historical relics of the past. Today, practitioners mostly emphasize on the treatments of organs and body substances stemmed from the Westernized integrative approach.

Most practitioners' training and practices are mostly based on TCM, a Chinese medical curriculum based on integrative medicine during the Chinese Cultural Revolution in the 1960s. Unless one has spent time outside of institutional setting and learning from traditional medical lineages, then he/she may not be using the "thousands of years" terminology properly.

It "must" work - it is also a dangerous term. How effectiveness of a clinician is based on his knowledge and experience, it is not based on a historical claim. 

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4. Acupuncture is only for relieving pain

Curiously, this is not a new sentiment. In early 1700's, lamenting the losses of acupuncture knowledge and technique & inadequate training of the acupuncturists, Xu Lingtai observed:

In the antiquity, acupuncture could effectively treat malaria, cold damage, fever, chills, coughing, and all illnesses of the organs and orifices. Today, acupuncture is only for illnesses of the channels, vessels, physical body, atrophy, painful obstruction, and tendino-muscular flexibility.

"Treatise on the Medical Lineages," translated by Allen Tsaur

With sufficient training, studies, and experience, acupuncture should be able to first address pain, then headache, nausea, vomiting. Then he should expand his capacity to address most conditions listed above from WHO.

Later in his career, he should strive to address most if not all conditions.

 

Acupuncture, throughout Chinese medical history, was a standalone medical modality. Its practitioners were tasked with the charge to treat everything they encountered. They were not limited by the confine of the medicine, but by the confine of each practitioner's competency.

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5. Acupuncture takes time

This really depends on each individual's conditions as well as the symptom's chronicity. Acute conditions tend to resolve faster. At times, an acute pain could be resolved right after the needle insertions; however, there are also instances that it takes 10-15 treatments just to improve the conditions.

In brutally honest terms, the reason why treatment takes so long to see any effect could be due to inadequate treatments by the practitioner or the difficult conditions of the patient. The ray of hope is, acupuncture treatments are cumulative. As long I do not make wildly wrong mistakes, every visit should improve the underlying constitute of the patient. In plain words, treatments will have compounded healing effects. 

In the end, it is every consumer's right to evaluate if the clinical outcome justifies the time, monetary cost they spent in treatments. Personally, I can never guarantee a favorable outcome for every case; yet, I strive to cultivate my skill in order to help you justify the means.

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6. "I do not treat diseases, I treat your holistic well-being"

This is a common catch-phrase of contemporary acupuncturists and herbalists. As a practitioner myself, whenever I make this statement, there are a variety of complicated motivations behind it. Let me break that down:

1) We are required by the code of ethic to say so 

A licensee may not make a guarantee or promise about the efficacy of a particular treatment, the licensee's practice, or the result of a treatment unless supported by scientific principles accepted by the profession.

Maryland, BOARD OF ACUPUNCTURE Code of Ethics 
https://health.maryland.gov/bacc/Documents/ethics_1208.pdf

In plain words, unless I can provide peer-reviewed scientific evidences that support my claim, I cannot say that I am treating the said disease. 

But let's put the legality aside, can Chinese medicine really treat diseases?

As all answers in Chinese goes, the answer should be an yes and a no.

Yes, there are well-documented study of disease study, in term of pathology, treatment, preventive medicine. The most famous example being the surviving copy of Chao Yuan-Fang's “Treatise on the Origins and Symptoms of Disease,” dated in 610 AD, which compiles a massive collection of 1739 diseases, their pathology, and their treatment principles. So any claim that Chinese medicine does not treat diseases should be disapproved if not rejected. 

But it is also a No. Since it depends on which disease we are talking about - we may have diseases unknown or failed to address in the past. In addition, even if a disease is well documented in the past, it may not be effective or performed up to bar with modern standard. This begs the questions of, what do you mean by treating diseases? What are your expectations? These are complex motivations that usually simplify the response to, "No, we do not treat diseases." 

2) At times, it does reflect considerations from classical Chinese medical principles,

There is a well-documented treatment principle in the discussion of "root-branch treatment" - where "root" is often interpreted as the constitute, and "branch" as the symptoms.

[When people] speak of branch and root, this is easy and yet they do not reach [the core of it]. To treat contrary to [the requirements], that is opposition; to treat in agreement with [the requirements], that is compliance.


When the disease is first and a movement contrary [to its regular course] occurs afterwards,
treat its root.
When a movement contrary [to its regular course] is first and the disease occurs afterwards,
treat its root.
When the cold is first and a disease emerges afterwards, treat its root.

When the disease is first and cold emerges afterwards, treat its root.
When the heat is first and a disease emerges afterwards, treat its root.
When the heat is first and central fullness emerges afterwards, treat its branch.
When the disease is first and outflow occurs afterwards, treat its root.
When an outflow occurs first and another disease emerges afterwards, treat its root.

When the disease is first and central fullness emerges afterwards, treat its branch.
When central fullness is first and a vexed heart [emerges] afterwards, treat its root.
When urine and stools do not pass freely, treat its branch.
When urine and stools pass freely, treat its root.21

When a disease breaks out and there is a surplus, [view] this as root and branch. {First treat its root and afterwards treat its branch.}
When a disease breaks out and there is an insufficiency, [view] this as branch and root. {First treat its branch and afterwards treat its root.}

Carefully investigate whether it is light or serious, regulate it on the basis of reasoning. In light cases move [against all of them] jointly; in serious cases move [against each of them] alone.”

Suwen Chapter 65, translated by Paul Unschuld

In most cases, except where there is obstruction in the GI track, bowel movement, and urinary function, the classical principles suggest that the practitioner should first address the constitute of the patient before taking on the symptoms. This however, leads to the next  consideration.

3) Am I dictating the treatment out of competence or out of incompetence?

If you come in for a knee pain, do I tell you this phrase that I am not treating your knee because

a) I can effectively address your concern, but I find it more worth-while to address your constitute first - either that symptom-oriented treatment approach may only be temporarily effective, or could be detrimental in the long run,

b) I do not have the confidence of effectively addressing your concern, so I am telling you this to lower your expectation

c) I have ulterior motives, often of financial incentives, that I hold back your treatment outcome,

This, I am afraid, is often the main motivation of why many practitioners use the phrase, "I do not treat diseases, I treat your holistic well-being"

drtsaur@gmail.com | Germantown, MD | © 2020 by Wind Lake Acupuncture