Dr. Samo Pitamic, a journalist from Medicine Today in Slovenia interviewed Medical Acupuncture Associate Editor, Gerhard Litscher, MSc, PhD, MDsc, head of the Traditional Chinese Acupuncture Research Center at Medical University of Graz, Austria.
With establishment of “scientific medicine,” which could be—at least formally—placed in line with a Flexner report (1910), the financial support of research institutions, not based on the Cartesian model, was stopped. All other medical systems, like traditional herbology, homeopathy or naturopathy, became, all of a sudden, nonscientific and have got a sign of inferiority.
Dr. Pitamic:I would like to know about the status of traditional Chinese medicine (TCM), especially concerning that we are living in a time, when the mechanisms behind traditional system of TCM are being—at least partly—revealed? One of the key phenomena, which impressed western society when it was first faced with Chinese medicine, was probably the phenomenon of biopotential (Qi), circulating in an authentic system of channels. Are we, with the current knowledge, in a position to explain both phenomena?
Dr. Litscher: Yes, the researchers are trying to explain both phenomena, with our current knowledge and techniques. For example, some studies try to demonstrate that Qi is closely related with oxygen metabolism. Channels—if they really exist—seem to have many special characters, such as special infrared radiation trajectory, acoustics, electrical resistance properties of the skin, higher luminous intensity and so on.
Researchers observed the phenomena of channels according to the records in classic books and in clinical practice; it is the [basis] of acupuncture and moxibustion therapy. However, studies have not shown special anatomic tissues along the channel. A more common view holds that channel and channel Qi is mixed complex of information, function and energy. When we cannot see the quantum or the magnetic wave, we cannot deny its existence. I think, with the development of our knowledge and using innovative techniques, we may disclose the mystery of channels or meridians so that we will understand some mechanisms behind all of these traditional methods.
Dr. Pitamic:If I understand the work of your laboratory correctly, you are in the middle of two systems, much like being situated on a razor blade. Since what only counts are scientifically obtained results, I wonder if you can consider the elements, which are the true base of the TCM system (like dualistic yin/yang principle, five elements) in your work?
Dr. Litscher: Yin and yang principle and five elements are the true base of TCM system, while they are just the method to try to understand some phenomena of the physiology and pathophysiology of the human body. It is a kind of way to learn interconnections.
For example, the element water: Because of water's descent and moistening, all the things of phenomena with the property or action of descending, moistening, coldness, chill and storing pertain to water category. Through high abstraction, generalization, extension and deduction, these properties mean far beyond their original characteristics and state, and become the common properties shared among the “water” categories of substances and phenomena in the natural world. TCM correlates the internal organ with five elements, illustrating the functional features and pathological changes according to the interrelations among five elements.
So you can see yin and yang and five elements are just the method of TCM to illustrate nature world and the human body. In research, one has to take into account these methods.
Dr. Pitamic:The term of “personalized medicine” is currently very popular in modern medicine, although being actually inherent to TCM; the treatment in TCM is always adjusted to a specific patient. What has happened with the system transitioning from east to west? I feel like the same “simplification” is going on as with martial arts when being changed to western sports?
Dr. Litscher: It is quite right that TCM is always adjusted to a specific patient, that means individual treatment, as TCM theory emphasizes that treatment should be made according to personal character, as it holds that the human body is a whole organism, with close relation with nature, society and geographical environment. That is the holistic view which is very important in TCM theory and it is one of its key thoughts. So in clinical practice a doctor should consider the patient as a holistic organism, with relation to the nature (such as weather, season), background of society, living surrounding and geographical environment.
You say the truth that TCM medicine was simplified when transitioning from east to west as the education system is quite not enough for the western study of TCM. In China, a TCM doctor has to get a bachelor's degree after a study of five years in university, including one year practicing in the hospital. The courses for medicine last at least 3000 hours, and the ancient philosophy, culture and classics are compulsive, as they are also the basis of TCM. Even so many hours of study in the university are not enough for a good TCM doctor, they have to experience clinical practice in the hospital or follow good experts to apply the theory into practice. While for the western doctors or some practitioners, after one or two hundreds of hours of training, they can be certified to apply acupuncture or TCM in clinical practice. I have to say that such kind of simplification does not inherit the essence of TCM; it is just learning the techniques. In most cases TCM or acupuncture is effective when western doctors apply these in practice, but sometimes the effect is not as good as expected. We may reflect on the phenomena, is TCM or acupuncture not effective? Or do we apply it according to its essential theory? That is a very important issue in the development of TCM and acupuncture outside of China like in our countries in Europe.
Dr. Pitamic:Having in mind the complexity of the TCM system, I would like to get your opinion on the level of risk for scientific approach to reduce or even eliminate therapeutic effects of acupuncture treatment?
Dr. Litscher: We have to admit the complexity of the TCM theory and system, as it is based on the Chinese philosophy and culture, and includes epistemology and methodology that we cannot explain alone with statistical methods or with scientific approaches. It is quite different from the thoughts and methods of Western Medicine. On the basis of this knowledge, we can understand the existence of TCM and acupuncture contributes to its efficacy in clinical practice. Therapeutic effects of acupuncture treatment could not be neglected even though we need more large-scale controlled evidence. As far as I know, in China there are nearly 4,000 TCM hospitals and 800,000 inpatient beds in the hospitals, in which there are more than 500 million out-patient visits for TCM and acupuncture treatment a year. Besides, there are about 40,000 TCM and acupuncture clinics with 1.2 million out-patients visits a year. The patients give the best proof for the therapeutic effects of acupuncture treatment. In Austria, Germany and other European countries more than 80% of the patient also want to have TCM as a complementary method; only 16% trust in mainstream medicine alone.
Dr. Pitamic:It has been well recognized that acupuncture is effective in cases of so called functional health problems, like migraine, fatigue, mental illness, colitis, rheumatism, asthma and menstrual cramps. Are there also other indications, where you could confirm its effectiveness?
Dr. Litscher: The World Health Organization (WHO) issued a report about acupuncture in 2002. The report classified 103 diseases or disorders into four categories, which could be treated by acupuncture, according to the evidence from controlled clinical trials.
The indications of acupuncture come from clinical practice and experience before, but now more and more evidence comes from controlled clinical trials. Evidence-based clinical systematic reviews may make a conclusion from clinical controlled trials and update the newest information. And there are more and more clinical practical guidelines about acupuncture based on evidence assessment. For example, China Association of Acupuncture and Moxibustion issued twenty-five evidence-based clinical practical guidelines [for] diseases treated by acupuncture.
However, randomized controlled trials may need a lot of money. Funding from government or institutions should support such research. Doctors working as acupuncturists in practice or clinic have very good experience in applying acupuncture for the treatment of different kind of diseases. Each successful case with good effect will be of great value. Although it is not a controlled study, many case reports will provide data from real world, which also have enormous persuasive power.
Initiated from our main collaboration partner in China, the China Academy of Chinese Medical Sciences (CACMS) in Beijing (by the way, this is the institution from the first Chinese Nobel prize winner Prof. Tu Youyou in Medicine in 2015) there is an International Patient Registry Platform of Acupuncture-Moxibustion (www.amreg.org). The platform is only in Chinese at present, the experts from the CACMS are currently developing the English platform, and a multi-language will follow soon. Doctors can register and log in to input cases about life style related diseases like low back pain, obesity and early stage of diabetes. At the moment the information is limited. Anyway it is a good beginning.
Dr. Pitamic:There have been many attempts, trying to attribute acupuncture only a placebo effect. Are there any well designed, placebo controlled trials, to show its real effectiveness?
Dr. Litscher: First, it should not be denied that the general effect of acupuncture includes psychological effects or effects on spiritual mind, as in ancient classics of Chinese Medicine, the theory of acupuncture stresses a lot on regulating spiritual activities during acupuncture treatment. The acupuncturist should concentrate on the treatment progress, observing carefully the patients' feelings and the phenomenon of the Qi arrival, and trying to maintain Qi during manipulation. The patients should keep calm and quiet during the treatment progress so as to feel Qi arrival. Thus the therapeutic effect will be achieved. However, acupuncture is not only a placebo effect. Besides our experimental studies there are well-designed randomized controlled trials which give evidence that acupuncture is effective. As published recently, well-designed randomized controlled trials reported that acupuncture is effective for functional constipation, migraine, low back pain and so on.
Dr. Pitamic: I know that you explore very intensively the laser acupuncture. Are the therapeutic effects really comparable to classic acupuncture method?
Dr. Litscher: This is a fascinating aspect. Indeed the results from laser acupuncture are comparable with that from manual needle acupuncture. At the moment we can measure the effects of laser acupuncture in the brain and in the periphery, however we do not know the mechanisms behind. This will be one of the challenges for future research activities.
Dr. Pitamic:What about the influence of different wavelengths of laser light in context of its therapeutic use?
Dr. Litscher: We are investigating different kinds of laser acupuncture (infrared, red, blue or violet, green and yellow). Each wavelength has advantages and disadvantages. For example the penetration depths of infrared and red laser are about 3 to 4 cm whereas those of violet lasers are only 1 to 2 mm. Green laser also does not have a very high penetration depth. On the other side we have investigated for the first time worldwide yellow laser. This kind of laser is also (like infrared and red) able to penetrate the human scalp and skull and therefore in the future non-invasive laser stimulation for the brain will also be a topic of interest mainly for patients with stroke or dementia and other neurological diseases. You can see our research is more than laser acupuncture. I am convinced that laser stimulation will have a broad field of application in the near future.
Dr. Pitamic:What about the fact that there is no feeling of pain with laser acupuncture? Although this is one of the main advantages compared to classical acupuncture, but when you—as a patient—don't feel anything, could it influence the treatment results?
Dr. Litscher: One of the main advantages of laser acupuncture is that it is painless. Patients in Europe like this kind of acupuncture. However in China the patient often asks the acupuncturist to intensify the stimulation with the needle so that he can feel the so called DeQi sensation very strong.
Less people know that you can have similar effects also with different kinds of lasers. Violet laser for example makes a strong sensation. You can feel it as electrical sensation with increasing feeling of warmth. For the stimulation with needles the acupuncturist is rotating and twisting the needles. In laser acupuncture it is also possible to perform adequate stimulation because we have different frequencies.
In laser acupuncture research however there is one big advantage that the patient does not feel the stimulation: for the first time it is possible in acupuncture research to perform really double blind studies. This was not possible in the past. The patient cannot feel the stimulation and a computer instead of the acupuncturist can switch on and off the stimulation.
Modernization of TCM and especially acupuncture using modern technology and performing transcontinental high-tech acupuncture studies is no longer a future vision. It has become already reality.
