Friday, January 15, 2010

The Untold Story of Acupuncture

this is an article from FACT

The untold story of acupuncture
by Ben Kavoussi


Chinese medicine
medical astrology
New Age medicine
‘One of the major problems marking studies of traditional Chinese concepts of healthcare in the west is a lack of familiarity with our own European/western traditions.’
Paul Unschuld

Traditional acupuncture – as we know it in the West – is an integral part of a system of diagnosis and treatment, commonly called traditional Chinese medicine (TCM) or oriental medicine and allegedly based on the natural philosophy and the scholarly medical knowledge of ancient and medieval China.1,2 Nonetheless, given the limited number of reliable translations and critical analyses of Chinese medical classics in English, most of our knowledge about this natural philosophy and its underlying belief system is either based on the official publications of the People’s Republic of China (PRC) or on a secondary literature published outside of PRC by practitioner-advocates who often do not have any familiarity with the Chinese language and medical history, and who have never, or at best for short periods, been to China.3 Remarkably, one of the main publications by the Foreign Languages Press of PRC explicitly states that the traditional tenets of acupuncture are ‘naive’ theories with ‘definite limitations’ that should only ‘serve as an analogy to explain some of the physiological functions of human organs’.4 In contrast, the majority of the publications by Western advocates of acupuncture maintain more or less that the natural philosophy and medicine of ancient and medieval China were based upon ‘an approach to health and disease, to reality and the altering of reality, completely foreign to the West.’5 It therefore appears that these publications foster a set of preconceived ideas and ideals about approaches to health and disease that the official Chinese publications, paradoxically, describe as ‘limited’ and ‘naive’. In addition, the all-pervasive belief among Western authors in a fundamental difference between the general approaches to reality in the orient and in the West amounts to what the critical theorist Edward Saïd (1935–2003) has called one of the four ‘principal dogmas of Orientalism’, meaning an unfounded ‘style of thought based upon an ontological and epistemological distinction made between the Orient and the Occident’.6

This article argues that in contrast to what is claimed in the Western literature, acupuncture’s underlying belief system is significantly similar to concepts of health and disease that underlined European and Islamic astrological medicine and bloodletting throughout the middle ages. It also argues that a postulated relationship between specific points on the skin and internal organs or between points and various effects on the body is not uniquely Chinese, nor is it unique to acupuncture.7 In addition, given the metaphysical nature of this association, it is not unforeseeable that in well-conducted trials that compare ‘real’ and ‘sham’ exposures, traditional acupuncture consistently fails to yield significant effects beyond control needling. It finally argues that the recent flurry of interest and research in traditional acupuncture is predominantly motivated by orientalism and consumerism, and stems more out of the postmodern reaction against the scientific and mechanistic rationalisation of human nature than the historical reality of its development and prevalence in China.8

Whereas the medical use of filiform needles is commonly equated with acupuncture, there is an actual distinction between their use in myofascial trigger point therapy, also known as ‘Western medical acupuncture’ or ‘dry-needling’ or ‘needling therapy’, and in traditional acupuncture.9 Dry-needling is a modality within manipulative medicine and physical therapy that uses acupuncture needles to stimulate the nervous system or painful points in ‘hyperirritable spots in skeletal muscle that are associated with a hypersensitive palpable nodule in a taut band’, which is an endogenous localised ‘contracture’ within the muscle without activation of the motor endplate.10,11 This modality is principally used by physicians, physiotherapists, nurses and other primary care providers in rheumatology and orthopaedics to treat musculoskeletal pain.12 Its use is largely evidence driven, although as with treatment in many areas, it still relies on the clinicians’ experience alone.13 Needles might also be used to deliver a low voltage electric current inside muscles, to stimulate either around or immediately adjacent to the nerve serving the hypersensitive area. This modality is known as ‘percutaneous electrical nerve stimulation’ or PENS. Trigger point dry needling and PENS are based on neurophysiological and biomechanical principles that have no correlation with traditional acupuncture other than the use of thin needles. A growing number of clinical studies support their use for the management of neuroskeletomuscular pain syndromes alone.14 Contrary to acupuncture, this type of therapy does not intend to treat conditions associated with internal organs or systemic diseases; it does not require knowledge of channels and points, and is erroneously associated with Chinese medicine.15 This article is not about trigger point dry-needling, Western medical acupuncture, electrotherapy or PENS. It rather aims to deconstruct the prevalent myth of traditional acupuncture as an alternative, holistic, independent and ‘heal-all’ medical system of Chinese origin that is presumably based on perceptions of health and disease completely foreign to the West.

As above, so below
Acupuncture is presumed to have its origins in blood ritual, magic tattooing and body piercing associated with Neolithic healing practices.16,17 The Neolithic origin hypothesis is supported by the presence of non-figurative tattoos on the Tyrolean ice man – an inhabitant of the Oetztal Alps in Europe – whose naturally preserved 5200-year-old body displays a set of small cross-shaped tattoos that are located significantly proximal to traditional acupuncture points. Medical imaging shows that the middle-aged man suffered from lumbar arthrosis, and the tattoos are located at points traditionally indicated for this condition.18,19 Similar non-figurative tattoos and evidence of therapeutic tattooing, lancing and blood ritual have been found throughout the ancient world including the Americas.2022 They appear to be largely intended to maintain balance with the natural and spiritual worlds, and to protect against demonic infestation and malevolence. Seemingly, this Neolithic and Bronze Age heritage that was indubitably intertwined with sympathetic magic and animism has evolved in various cultures into codified systems of lancing and venesection for ensuring good health and longevity. In addition to treating the impurity or superabundance of blood, lancing was also believed to affect the flow of a numinous force that is called ‘qi’ (氣) in Chinese, ‘prāna’ (पण) in Sanskrit, ‘pneuma’ (πνεύ;μα) in Greek, etc.23 In many of these ancient cultures elements of mythology, mysticism, metaphysics, astrology, numerology, geomancy and empirical medicine were inherently intertwined, making it difficult for modern scholars to interpret them as mutually exclusive categories. In China, for instance, the numinous qi was believed to mirror the sun’s annual journey around the celestial sphere and to circulate in a network of 12 primary ‘jing luo’ (經络) known in English as the ‘chinglo channels’, or simply ‘channels’ or ‘meridians’ (a term coined in 1939 by George Soulié de Morant, a French diplomat), which run from head to toes and interconnect approximately 360 primary points on the skin.24 There is a strong possibility that the web of these channels was a rudimentary model of the vascular system that was conceptualised according to an ‘episteme’, meaning a set of fundamental beliefs, based on astrological principles. Each channel was believed to be linked to a specific internal organ system and to a 2-h (30°) house of the Chinese zodiac system ‘di zhi’ (地支), known in English as ‘earthly branches’. Each channel was named according to its degree of ‘yin’ (阴) and ‘yang’ (阳), from ‘tai yang’ (太阳) to ‘jue yin’ (厥阴), which are also terms that describe the phases of the sun and the moon.25 Each channel has five special points designated by the characters 水 (water), 木 (wood), 火 (fire), 土 (earth) and 金 (metal), which are also the Chinese terms for Mercury, Jupiter, Mars, Saturn and Venus.26 The journey of qi in the body is often described in terms such as:

‘The major premise of Chinese medical theory is that all the forms of life in the universe are animated by an essential life-force or vital energy called qi. Qi also means ‘breath’ and air and is similar to the Hindu concept of prāna. Invisible, tasteless, odourless and formless, qi nevertheless permeates the entire cosmos. Qi is transferable and transmutable; digestion extracts qi from food and drink and transfers it to the body, breathing extracts qi from air and transfers it to the lungs. When these two forms of qi meet in the bloodstream, they transmute to form human qi, which then circulates throughout the body as vital energy. It is the quality and balance of your qi that determines your state of health and span of life.’27

Other texts refer to qi as a ‘cosmic spirit that pervades and enlivens all things’28 and ‘gives rise to change.’29 For instance, the alchemist Ko Hung (葛洪, 2nd–3rd century) writes that ‘Man is in qi and qi is in each human being. Heaven and Earth and the ten thousand things all require qi to stay alive. A person that knows how to allow qi to circulate will preserve himself and banish illness that might cause him harm.’30,31 The belief in a ‘cosmological correspondence’ between the houses of the Chinese zodiac and the chinglo channels seems to be based on the doctrine of ‘as above, so below’, which stipulated that everything in the heavens has its counterpart on earth and also in man. The doctrine is explicitly stated in the Yellow Emperor's Canon of Medicine (黄帝内经, huang di nei jing) as ‘Heaven is covered with constellations, Earth with waterways, and man with channels.’32 This doctrine was equally prevalent throughout the ancient world, including in the eastern Mediterranean cultures. It is notably found in the relics of a collection of occult writings called the Corpus Hermetica, which are believed to have been compiled in hellenistic Egypt during the 1st or 3rd century and are attributed to Hermes Trismegistus (‘Thrice-great Hermes’), the Greek equivalent of the Egyptian god of wisdom, Thoth. The original text was presumably lost or destroyed during the systematic annihilation of non-Christian literature between the 4th and 6th centuries. Nonetheless, a section of it, known as the Emerald Tablet, survived and was translated into Arabic by the Muslim conquerors and later into Latin by John of Seville (c. 1140) and by Philip of Tripoli (c. 1243). An Arabic version by the Muslim polymath and alchemist Abu Musa Jābir ibn Hayyān (c 721–c 815) states ‘That which is above is from that which is below, and that which is below is from that which is above, working the miracles of One.’33 Given the prevalence of this doctrine throughout the ancient world, it seems that the natural philosophy that has given rise to acupuncture in China stems from the same set of cosmological beliefs that were equally prevalent along the Silk Road in Persia, Mesopotamia, Egypt and in Greece and that have influenced the health and safety beliefs of pre-Christian Europe, such as the eastern Mediterranean mystery cults,34 as well as the early Gnostic Christianity.35 This hypothesis is supported by a statement by Gregor (Gregorius) Reisch (c. 1467–1525) in Margarita Philosophica (Pearl of Wisdom), first published in 1503:

‘The pagans believed that the zodiac formed the body of the Grand Man of the Universe. This body, which they called the Macrocosm (the Great World), was divided into twelve major parts, one of which was under the control of the celestial powers reposing in each of the zodiacal constellations. Believing that the entire universal system was epitomised in man’s body, which they called the Microcosm (the Little World), they evolved that now familiar figure of ‘the cut-up man in the almanac’ by allotting a sign of the zodiac to each of twelve major parts of the human body.’36

Based on this doctrine, European physicians practised what is called ‘Iatromathematics’ – also known as ‘astrological medicine’ or ‘astromedicine’ – until the 17th century. They utilised planetary transition tables called ‘ephemerides’ or ‘Alfonsine tables’ to cast a prognostication – meaning an outcome prediction based on astrological conjunctions, alignments and the angle between planets (aspects) – and to perform venesection, cupping, cauterisation, surgery or to prescribe medicines with specific astral powers.37 Disease was then believed to result from interruptions to the flow of the numinous ‘pneuma’ and an imbalance in the four ‘humors’ – blood, yellow bile, black bile and phlegm, which were each associated with an element, a planet, etc. Therapy consisted of purging the offending humor and its noxious pressures during favourable aspects. Most bloodletters would open a vein in the arm, leg or neck with a fine knife called a ‘lancet’. They would tie off the area with a tourniquet and hold the lancet delicately between thumb and forefinger and strike diagonally or lengthwise into the vein to avoid severing it. They would then collect the blood in a measuring bowl.38 Initially, according to the classic Greek procedure, blood was let from a site near the location of the illness, but later the physicians drew a smaller amount of blood from a distant site. This procedure not only required knowledge of the distal cutting points and the precise amount of blood to draw, but also the knowledge of ephemerides to establish the suitable aspects and timing. Medieval medical manuscripts therefore contained ephemeris charts (‘volvelles’) and the schematic of a body covered with astrological signs, generally known as ‘Zodiac Man’, which illustrated the specific influences of constellations on body parts and organs (Figure 1) and the location of the associated bloodletting points (Figure 2). The allotment of the zodiacs to each of the major parts of the body started at the head with Aries and ran down to the feet, which belonged to Pisces. Cancer was believed to be responsible for diseases of the lungs and the eyes and Scorpio the genital afflictions, for example.39 It is very plausible that the same principle is at the origin of acupuncture channels in China40 because the distribution of the regions of astrological influences and the related venesection points portrayed in medieval Islamic and European manuscripts significantly resemble the allocation of master, command, influential and other key points (Table 1).41 This argument is further supported by the fact that, as Paul Unschuld points out, the opening of superficial or deep-lying vessels for bloodletting seems to predate the manipulation of qi with needles.42 It is important to note that Greco-Arabic bloodletting was known in China and fragments of Avicenna’s (c. 980–1037) Cannon of Medicine were translated during the time of the Yuan dynasty (1271–1368) and published along with other Persian and Arabic texts in the Hui Hui Yao Fang (回回藥方), meaning the prescriptions of the Hui Nation, with much of the text in Arabic.43 The practice of bloodletting and cupping (hijama) to affect specific organs or to mitigate specific diseases based on a postulated relationship between the internal organs and corresponding points on the surface of the skin is still prevalent among Muslims worldwide, and video instructions for it are now available, even on YouTube. The correlation between Chinese acupuncture and bloodletting is further supported by the fact that the Chinese character zhe-n (針) historically refers to lancing with coarse needles or any sharp object used for scarification, bloodletting and minor surgery.44 Linda Barnes,45 in her remarkable book on how China, the Chinese, and their healing practices were imagined in the West from the late Middle Ages through to the mid-19th century, convincingly argues that there are sufficient apparent similarities that an early observer might have been excused for imagining that the Chinese and European practices grew from the same conceptual framework. Although she seems to agree with Paul Unschuld’s assessment that acupuncture emerged as an offshoot of bloodletting, she also notes that the early European observers seem to have misunderstood the ways in which the body itself was conceptualised by the Chinese, and assumed that they were simply using an inferior version of the Greek humoral system.

See Figure 1: .

See Figure 2: .

See Table 1: Similarities between Muslim and medieval astromedicine and acupuncture therapies.

Paradoxically, for most of China’s long medical history, the practice of lancing and bloodletting was actually the trade of itinerant folk-healers and were considered a lower class of therapy than the use of pharmacopoeia. As the historian Bridie Andrews Minehan describes:

‘The lowly acupuncturists engaged in a great deal of minor surgery, and the two specialties of acupuncture (zhenjiu) and external medicine or surgery (waike) overlapped considerably. Illustrations of the nine needles of acupuncture, featured in many handbooks from the late imperial period, depicted scalpel-like knives, cautery irons, and three-edged bodkins for bloodletting and lancing boils, as well as the fine needles we currently associate with acupuncture.’46

Andrews Minehan also notes that although needling is often cited in the Yellow Emperor’s Canon of Medicine, throughout the history of China relatively little has been written on it elsewhere. Reportedly, by the middle of the second millennium its practice was mostly abandoned, and eventually the Chinese and other Eastern societies took steps to eliminate it altogether.47 In 1822 an edict banned its teaching and practice from the Imperial Medical Academy, the institution that provided physicians to the Court. The Japanese government equally prohibited the practice in 1876.48 However, in the early 1930s a Chinese paediatrician by the name of Cheng Dan’an (承淡安, 1899–1957) proposed that needling therapy should be resurrected because its actions could potentially be explained by neurology. He therefore repositioned the points towards nerve pathways and away from blood vessels, where they were previously used for bloodletting. His reform also included replacing coarse needles with the filiform ones in use now.49 Reformed acupuncture gained further interest through the revolutionary committees in the People’s Republic of China (PRC) in the 1950s and 1960s, along with a careful selection of other traditional, folkloric and empirical modalities to create a makeshift medical system that could meet the dire public health and political needs of Maoist China while fitting the principles of Marxist dialectics. Chairman Mao believed, however, that ancient natural philosophies underlining traditional therapies represented a spontaneous and naive dialectical world view based on the social and historic conditions of their time and should be replaced by modern science.50 It is the reformed acupuncture of Cheng Dan’an and the makeshift medical system of Maoist China that flourished later in the West as ‘traditional Chinese’ or ‘oriental,’ and most recently as ‘Asian’ medicine. Currently, in every major metropolitan area in the USA and in Europe, one can find acupuncture boutiques where practitioners incorrectly claim that gently puncturing the skin with silicon-coated stainless-steel filiform needles is a scholarly medical tradition of ancient China that has been used for over 2000 years to relieve pain and to treat a variety of diseases. Meanwhile, and despite what is reported by the advocates, this gentle insertion of very fine needles at specific points on the skin has consistently failed in well-conducted trials to show compelling evidence of efficacy for conditions that are amenable to specific treatments.51,52 Whatever the clinical efficacy of any type of needling therapy, there is still no convincing evidence that acupuncture points and meridians exist as discrete entities, distinct from blood vessels and nerves.53

New Age consumerism
Although acupuncture has been known in the USA since the 19th century, its therapeutic claims were dismissed or judged to be ‘much overrated’ by the medical community.54,55 However, the publication of an enthusiastic report in the New York Times by James Reston, a reporter in President Nixon’s press corps who had received acupuncture for postoperative cramps in Beijing in 1971, changed this perception and triggered a flurry of interest among the American public, and some in the medical community.56 Within the following months, journalists, scientists and physicians made pilgrimages to China, most reporting their observations in the popular press and a few in scientific journals. Some reported that thousands of successful operations of all kinds were being carried out in the PRC using acupuncture anaesthesia; others described its use for a host of pain syndromes, both acute and chronic; some even claimed its miraculous efficacy for treating paralysis and deafness.57

These unconfirmed claims in the heady social and intellectual climate of the 1970s – meaning the American counterculture: the rejection of mainstream values; the hippie ideology and the cult phenomenon; revolutionary ideas mixed with environmentalism; avoidance of pollution and chemicals; alternative lifestyles; a syncretistic mix of drugs, Eastern religions and native American spiritualities; the resurgence of the taste for mystic, occult, and magical phenomena;58,59 and the belief in the existence of a separate and non-ordinary reality, such as the one confabulated by one of the fathers of the New Age movement, Carlos Castaneda,60 gave the justification to view acupuncture as a ‘heal all’ alternative therapy based on alternative perceptions of reality. This notion was soon popularised by a series of introductory books by holistic health ‘gurus’ and ‘scholars’ on the specific effects of points along imaginary lines on the skin through which a numinous force journeys by 2-h intervals. None of these gurus and scholars, however, noticed the obvious link between acupuncture and astrological medicine. Instead, they erroneously popularised a lancing modality that throughout its history was largely performed by illiterate folk healers using crude needles to induce bleeding as a gentle, natural, holistic and scholarly approach to health and disease that is based on over 2000 years of development and refinement in the Far East, and is miraculously able to maintain or to re-establish harmony within the individual organism, or between the organism and the larger microcosm, while remaining free from the constraints of the so-called ‘repressive rationality’ of science in ‘overdeveloped’ societies.61,62 Moreover, most publications also alleged that Eastern healing arts have crucial characteristics directly and unequivocally opposite to the West, such as holism and incredulity in the notion of causation in pathogenesis. Paradoxically, while the theme of ‘evidence of effectiveness’ gradually became a central part of international, national, and regional public health dialogue in the 1980s and 1990s,63 a conceptual chimera called traditional acupuncture which reflected more post-Counterculture and New Age ideas and ideals than the historical reality of the history of medicine in China was legitimated and regulated across the USA, with disregard for its authenticity and efficacy.

One of the main sociocultural reasons behind the erroneous belief that Chinese natural philosophy is based upon a frame of reference completely foreign to the West, is our collective amnesia that results in our perception of acupuncture as a modality distinct from medieval bloodletting, and the notion of qi as different from pneuma and other vitalist notions that have been part of European natural philosophy since Greek antiquity. Indeed, as a result of successive epistemological ruptures64 during the last five centuries, medicine in the West has gradually evolved from late medieval astromedicine and humoral pathology to the molecular medicine and cellular pathology of the present. Therefore, fundamental notions that once underlined European medicine have gradually become so foreign to us that their Eastern counterparts now seem to be based on world views fundamentally different to ours. In the eyes of many historians and epistemologists, they have always appeared similar to ideas that prevailed in pre-enlightenment Europe and based on which the Fasciculus Medicinae65 and the other late medieval medical treatises were written.

In addition, these late medieval notions of health and disease find an audience today due to the postmodern opposition to enlightenment rationalism and the claim that science does not provide more access to the truth than any other fields of knowledge – that scientific discourse is presumably just another coherent ‘narrative’ or ‘language-game’ governed by a set of protocols and a special terminology.66,67 Non-scientific forms of knowledge have therefore gained legitimacy over the past few decades as a result of the predominance of consumerism. In this climate of incredulity towards ‘metanarratives’ and universal knowledge, many local, folkloric and traditional systems of medicine have appeared as an alternative medical discourse, legitimate and equivalent, but opposite, to the logical empiricism of modern medicine.

One other reason for this flurry of interest in Eastern medicine is grounded in what the late Edward Saïd called ‘orientalism’. In a 1978 publication by the same name,6 Saïd convincingly argued that the idea that Eastern cultures have crucial characteristics directly and unequivocally opposite to the West is an occidental construct that ‘exotices’ the East while neglecting considerations of power. Saïd argued that the alleged distinction between oriental and occidental thought primarily derives from a set of scholarly fantasies about Eastern civilisations, classical eras, golden ages, scriptures, works of art, philosophies and religions in which mysticism is set against the rationalism and detachment of the West.68 He also argued that this mythical orient is a mere fiction that serves to represent the hidden desires of Western cultures, a mysterious ‘other’ onto which we project our fantasies.69 Given the pervasiveness of such a projection of ideals onto acupuncture, it certainly seems that Saïd’s argument directly applies to oriental medicine, for it fosters and promotes many of the unexamined assumptions about Eastern reactions to health and disease. The fictional cohesiveness of this ‘other’ medicine can be further perceived in the indecisiveness of the professional associations and the regulatory agencies to call acupuncture and related modalities ‘Chinese’, ‘oriental’, ‘Asian’ or ‘Eastern’, for these denominations are based on political correctness, rather than the historical reality of their development and prevalence in the Far East.

To these sociocultural reasons must be added the recent inclination towards consumerism in health economics and the desire to accommodate New Age health consumers, who are disenchanted with modernity, materialism and reductionism, and who, instead, aspire towards traditionalism, spirituality and holism.70 A rearranged, reformed, repackaged and relabelled derivative of astrological medicine can therefore be easily marketed as ‘oriental medicine’ to consumers who believe in a vast spectrum of ideas and practices sourced by Eastern religions, paganism, alternative science, astrology and a range of other New Age beliefs emanating out of a general interest in the paranormal.71,72 In a fascinating article on cults in America, Camille Paglia explains how the New Age movement gradually became an international commercial success in the 1990s with specialty shops and mail-order catalogues supplying the ‘ritual paraphernalia of amulets and talismans, healing crystals, angel icons, incense, candles, aromatherapy bath salts, massage rollers, table fountains, wind chimes, and recordings of trance music in Asian or Celtic moods.’73 To this, she could have added herbal products, various types of yoga, chakra and energy healing, tai chi, qi gong, reflexology, reiki, shiatsu and also acupuncture, in which as Robert Frank and Gunnar Stollberg74 have argued ‘physicians tailor their practice to the individual patient’s (perceived) demands’. This international commercial success has undeniably benefited China’s export of acupuncture-related products, especially when their domestic use is in sharp decline due to the broader availability of modern medicine in a country that strives to reach the top in science and technology.

Final thoughts
Despite acupuncture’s popularity, a recent systematic review of literature by Howard Moffet75 revealed that traditional acupuncture theories often lead to null outcomes in well-conducted trials and are unreliable for creating distinct exposures. So far, the dominant scientific rationale for acupuncture involves the release of neurochemicals (such as endorphins or anti-inflammatory cytokines) due to homeostatic phenomena known as counter-irritation and counter-inflammation, but there is little evidence that this release depends on any specific points or means of stimulation. As the difference between ‘real’ and ‘sham’ acupuncture has not been clearly demonstrated, Moffet75 concludes that the theoretical basis for acupuncture practice and research needs to be re-evaluated.

His conclusions finally validate what many epistemologists, historians of medicine and sinologists have all along suggested: traditional acupuncture is related to bloodletting and cauterisation; it is motivated by the pervasive doctrine of ‘as above, so below’ and the computation of celestial patterns; and there is considerable doubt about the veracity of the prevalent rhetoric of over 2000 years of ‘trial and error’ in the establishment of channels and points, for the fundamental tenets of acupuncture are devoid of empirical rationale. However, a set of socioculturally and commercially motivated pseudo-truths and false certitudes about the origins, historical context, and the prevalence of acupuncture and related modalities in China have led to its current cult in the West as a New Age panacea that allows the harnessing, guiding and adjusting of a ‘Promethean flame’ naturally to restore health and longevity.

In addition, there is now considerable evidence indicating that acupuncture, hypnosis, meditation, prayer, guided imagery, biofeedback and the placebo effect share neural correlates.7678 This evidence indicates that the use of specific points and particular types of stimulation are not critical factors independent of conditioning, expectancy or other placebo factors.79,80 This argument is consistent with the imaging studies at the University of Pennsylvania, which have shown statistically significant changes in cerebral blood flow in subjects engaged in meditative prayer and also in those receiving acupuncture.81,82 It also remains consistent with studies by Zeltzer et al.83 and Waterhouse et al.,84 who have shown potential synergistic effects between acupuncture and hypnosis.85 Indeed, as Dhond et al.86 have reported, it is highly likely that acupuncture stimulates a common and widely distributed network of brain regions, and that the alleged point-specific effects are subtle and depend directly on the patient’s neuropsychological disposition.

Finally, given how unconfirmed claims in the popular press in the 1970s created an enormous interest for acupuncture in the USA and in Europe, and how many books by Western ‘scholars’, who often did not have any familiarity with either Chinese or European medical history, popularised a set of unexamined assumptions about acupuncture, it is perhaps pertinent to evoke Bernard le Bovier de Fontenelle’s (1657–1757) advice, who in 1687 in his Histoire des Oracles wrote what should have been the ‘mantra’ of all endeavour and publication in complementary and alternative medicine: ‘if the truth of a fact were always ascertained before its cause inquired into, or its nature disputed, much ridicule might be avoided by the learned.’87