The place of research in TCM (methodology)

[Guest guest]

In those two major studies of headaches that published result last

year, two facets stand out for me. (These were the one in Britain,

and the one in Germany both multi-site, multi-investigator,

establishment sponsored (governmental, industry institutions), and

very carefully designed.)

 

1) In the British one, addressing migraine headache, the methodology

did not specify treatment modality, as I recall, but simply the

dimensions of a course of treatment. They handled the patients over

to qualified acupuncturists to treat as they saw fit. The goal, as

reflected in the conclusions, was to discover if the modality in

general performed well in a socio-economic perspective. Apparently

(statistically) it did, so it was then recommended for inclusion in

the national insurance system.

 

To my mind, and relative to the discussion here, scientific inquiry

may or may not need to focus on protocols or patterns or the like to

come to relevant findings. Also that the impulse to test specific

mechanical details of AOM may belie a Western bias, i.e. a less than

purely scientific attitude.

 

2) The German study, which actually had two parallel sets of arms

addressing, respectively, tension and migraine HA. used specific

protocol control -- the famous verum vs sham acupuncture. Verum here

was orthodox TCM protocol. In the migraine study, for instance,

GB-20, 40, 41 or 42; Du20, LR3, SJ3 or 5, and TaiYang; plus other

points according to patient Sx. Not having Melchart's paper, which

detailed the sham protocol, in front on me now, but having once read

it, I recall the sham points were deliberately away from the defined

channels. I also seem to recall the use of shallow insertions.

 

In the tension HA study, verum was GB20, GB21, LR3; plus specific

additional points by type of HA. It was in this study the term

" minimal " was used instead of " sham " for the other arm one. These

points were: near LI14 and the acromium; one 2 " lateral to LU3; one

ulnar to the Ht channel, 1/3 out from the elbow; 1 " lateral to lower

edge of scapula; etc.

 

(As we all know, the results, in all three studies found acupuncture

significantly effective, and in the German studies, sham/minimal

acupuncture marginally more so.)

 

Remarkable to me, as a sufferer as well as treater of migraines, is

the use of as many or more needles for migraine compared to tension

type. In my experience, a principle (CM) differentiation is that

migraines tend to be deficiency (xu) conditions, tension HA mainly

excess (shi) conditions. I.e. for migraine, less needles, less

stimulation, perhaps more moxabustion than needling tend to be more

effective. There's something to be said for perhaps avoiding the

strong effects of direct channel dynamics, and for more superficial

application (as in some classical interpretations of sinew-channel

Tx), to address more the weiqi and circulation. Also in terms of

" ShaoYang harmonization " , as migraine (from the French from the Greek

" [he]mi-cranial " , ie half-head) tends to locate on one side of the

head, and can migrate between sides; and is said to be a vascular

disorder elevated pressure followed by relaxation and a dip in

pressure, and then phases of rebound back an forth.

 

Good studies inspires further ideas.

 

 

 

 

[Guest guest]

I just read an article which may be of interest to this discussion:

 

" The Efficacy Paradox in Randomized Controlled Trials

of CAM and Elsewhere: Beware of the Placebo Trap "

 

I have uploaded it to the files section of the group:

files > articles > theory.

 

Harald Walach's conclusions:

 

1) Argue against all those would-be methodologic

“popes” who want to make everybody

believe that efficacy is identical with

specific efficacy against placebo.

(2) Diversify research strategies to use multiple

methods, such as randomized comparison

trials of CAM therapies against standard

care or against waiting lists. This will

enable us to quantify general therapeutic

effects. Other research options would be

large outcomes studies or comparative cohort

studies in natural settings to address

selection process.

(3) Start emptying the placebo waste bin and

disentangle what it contains. Perhaps, at the

bottom, we will find what is at the base of

every true healing process: the capacity of the

organism to heal itself. Starting to ask the

question: “What is self-healing after all?” will

be the beginning of meaningful research and

will point the way out of the placebo trap.

 

 

[Guest guest]

In those two major studies of headaches that published result last

year, two facets stand out for me. (These were the one in Britain,

and the one in Germany both multi-site, multi-investigator,

establishment sponsored (governmental, industry institutions), and

very carefully designed.)

 

1) In the British one, addressing migraine headache, the methodology

did not specify treatment modality, as I recall, but simply the

dimensions of a course of treatment. They handled the patients over

to qualified acupuncturists to treat as they saw fit. The goal, as

reflected in the conclusions, was to discover if the modality in

general performed well in a socio-economic perspective. Apparently

(statistically) it did, so it was then recommended for inclusion in

the national insurance system.

 

To my mind, and relative to the discussion here, scientific inquiry

may or may not need to focus on protocols or patterns or the like to

come to relevant findings. Also that the impulse to test specific

mechanical details of AOM may belie a Western bias, i.e. a less than

purely scientific attitude.

 

2) The German study, which actually had two parallel sets of arms

addressing, respectively, tension and migraine HA. used specific

protocol control -- the famous verum vs sham acupuncture. Verum here

was orthodox TCM protocol. In the migraine study, for instance,

GB-20, 40, 41 or 42; Du20, LR3, SJ3 or 5, and TaiYang; plus other

points according to patient Sx. Not having Melchart's paper, which

detailed the sham protocol, in front on me now, but having once read

it, I recall the sham points were deliberately away from the defined

channels. I also seem to recall the use of shallow insertions.

 

In the tension HA study, verum was GB20, GB21, LR3; plus specific

additional points by type of HA. It was in this study the term

" minimal " was used instead of " sham " for the other arm one. These

points were: near LI14 and the acromium; one 2 " lateral to LU3; one

ulnar to the Ht channel, 1/3 out from the elbow; 1 " lateral to lower

edge of scapula; etc.

 

(As we all know, the results, in all three studies found acupuncture

significantly effective, and in the German studies, sham/minimal

acupuncture marginally more so.)

 

Remarkable to me, as a sufferer as well as treater of migraines, is

the use of as many or more needles for migraine compared to tension

type. In my experience, a principle (CM) differentiation is that

migraines tend to be deficiency (xu) conditions, tension HA mainly

excess (shi) conditions. I.e. for migraine, less needles, less

stimulation, perhaps more moxabustion than needling tend to be more

effective. There's something to be said for perhaps avoiding the

strong effects of direct channel dynamics, and for more superficial

application (as in some classical interpretations of sinew-channel

Tx), to address more the weiqi and circulation. Also in terms of

" ShaoYang harmonization " , as migraine (from the French from the Greek

" [he]mi-cranial " , ie half-head) tends to locate on one side of the

head, and can migrate between sides; and is said to be a vascular

disorder elevated pressure followed by relaxation and a dip in

pressure, and then phases of rebound back an forth.