| Acupuncture is a significant type of method for healing used in Traditional Chinese Medicine (TCM). Its mechanism is based on a strong foundational system of TCM theory, thus giving rise to its high treatment efficacy and its spread in China for thousands of years. As the era changes and with the encouragement of globalization, this is so even for acupuncture and TCM. At this point in time, foreign countries have also started to perform a lot of scientific research in acupuncture and the researches are becoming more in-depth and extensive. Since the early 1970s, acupuncture has become the main object of study in many scientific experiments. Because of this, we have developed a deeper understanding in the mechanism of acupuncture. However, among all these foreign scientific researches, not all yield positive results and conclusions. One of them is the claim that’acupuncture is just a placebo’. The high incidence of low back pain and its impact on people’s quality of life and the vast interest in Chinese domestic and foreign researchers of the treatment of low back pain with acupuncture makes this a meaningful research topic.Purpose:This paper will attempt to explore the reasons for the conclusions of ’acupuncture is just a placebo’to mostly come from foreign researches and not Chinese domestic researches by understanding the objectives and interest of the two counterparts in acupuncture researches; based on the exploration of the model of treatment efficacy studies used in foreign researches, this paper will attempt to understand the reason for the conclusion of’acupuncture is just a placebo’from this viewpoint; based on the exploration of the research methods and design problems encountered in acupuncture studies, this paper will attempt to understand the reason for the conclusion of’acupuncture is just a placebo’from this viewpoint. And finally the structural model of the research methods of evidence-based medicine used for traditional medicine research has to be remodelled and changed accordingly to suit the special features of traditional medicine.Methods:Research papers from countries other than China on probable RCTs of using acupuncture to heal back pain in the form of English language were recovered, with the timeline limited to 1994 till 2015. These papers were obtained from the search of three programmes, namely the Web of Science, Medline and Pubmed. Examples of the search words that were used to locate the papers were "low back pain" and "acupuncture" etc. Research papers from China on probable RCTs of using acupuncture to heal back pain were recovered, with the timeline set between 1994 till 2015. These papers were obtained via searching through China Academic Journal Database CNKI (1953-2013) and limited to journals such as Zhenjiu Linchuang Zazhi, Zhongguo Zhenjiu etc. The search words were "needle", "back". Exclusion criteria were those that were review, pilot trials, animal trials, surgery and post-surgery acupuncture treatments, letters to editors, papers on laser acupuncture, or injection of acupuncture points. Other than that, research papers from China and out of China and those other than those which were found inside the exclusion group yet still satisfy the inclusion criteria were retained. Grouping the papers into those from China and those out of China, analysis in the statistics of interest and objective of research was carried out. Hence, exploring possible reasons for conclusion like ’acupuncture is just a placebo’ to be prevalent in foreign studies but not in Chinese domestic studies; through exploring possible problems in research methodology and design, this paper attempts to question about the grounds for conclusions like ’acupuncture is a placebo’.Result:With regard to the medical trials of using acupuncture for healing low back pain, the range of focus by foreign researches is broader while that of the Chinese domestic researches is more concentrated. Among the foreign literature,11 of them are sham acupuncture controlled experimental studies and 6 of the sham acupuncture controlled experimental studies concluded that there is no distinction between the efficacy of real and sham acupuncture and 1 of the sham acupuncture controlled experimental study directly concluded that ’acupuncture is just a placebo’. The conflict in the treatment paradigm utilized by Western medicine and TCM, in which the Western medicine sees and treats illnesses in accordance to the mechanical cell-pathology paradigm while TCM follow the holistic non-specific physiological and pathological paradigm, and the incompatibility between the Western medicine and TCM efficacy studies basis, in which in Western medicine, for interventions to be accepted as effective, they need to possess efficacy’higher than that of placebo’, may be some reasons for the result in the conclusion of’acupuncture is just a placebo’. The lack of knowledge in modern acupuncture researchers of what could have caused acupuncture effects and how sham acupuncture stimulations can result in some healing effects on the body may have resulted in the ’efficacy’ of the sham acupuncture control group to relatively rise while the simplified and standardized use of treatment acupoints in foreign researches may have caused the efficacy of the real acupuncture treatment group to appear lower. Hence resulting in the conclusion of ’no distinction in the efficacy of real acupuncture treatment group and sham acupuncture control group’ and ultimately the allegations of ’acupuncture is just a placebo’.Conclusion:The interest of study of foreign researches is broader in scope than that of the Chinese domestic researches. Also, foreign researches involved sham acupuncture controlled trials and hence through such trials did the result of’there is no difference in the efficacy of acupuncture treatment group and sham acupuncture control group’came about. This then ultimately leads to the conclusion of’acupuncture is just a placebo’. Following the search into the root cause for such conclusion on acupuncture, it was found that the conflicting treatment and research paradigms that Western and Traditional Chinese medicine follow, coupled with the incomprehensive understanding of acupuncture by modern researchers and their flawed experimental designs made for acupuncture researches could have been the possible reasons for the result of the controversial conclusion that’acupuncture is just a placebo’. In actual fact, the term ’placebo’ and ’placebo effect’ are relevant to only a small part of research in Western medical pharmacology, and not for traditional complex interventions like acupuncture. Furthermore, if we explore the true meaning of ’placebo’ and ’placebo effect’ in traditional therapies, they are riot the undesirables that Western medical research world has long portrayed. On the contrary, they include elements and processes that cannot be controlled by researchers in experimental studies, such as the psychological and mental aspects of the patients. They, however, play a crucial role in complex traditional therapies. Tapping into the root of the problem, the gold standard as advocated by the hierarchy of evidence-based medicine research methods, which is randomized controlled trial, when used in traditional medicine research does not give a full and fair evaluation of the efficacy of traditional treatment methods. Therefore to study the efficacy of traditional medicine, the evidence-based medicine research method structure should be readjusted to reflect all aspects of the traditional medicine efficacy. And in this case, instead of the hierarchical structure, we may like to consider the ring structure research model. Traditional medicine, including acupuncture and other therapies cannot fully display its efficacy, not because the problem lies with the therapy itself, but because improper methods and means have been used for evaluating the therapy. Hence positioning well in the medical world and upholding its own philosophies are what traditional acupuncture therapy should imperatively be doing. |
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