Talk:Acupuncture/Archive 5

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Edit about MtrP points, Astrology

Our article says

”Kalichman and Vulfsons' 2010 clinical review confirmed that "ah shi" points are what are now referred to as "MtrP points”.

MtrP points are of questionable validity, based primarily on work by one person, and are on fringe in science, mainstream in alternative medicine. But that aside, maybe I am mistaken and missing something, but where do Kalichman and Vulfson say that their “review confirmed” that? PPdd (talk) 04:12, 28 January 2011 (UTC)

By all means, rephrase to more accurately reflect the review's finding.LeadSongDog come howl! 23:44, 1 February 2011 (UTC)

I can't see anything in the link comparing to placebo, or the level or significance of the effect. PPdd (talk) 08:44, 2 February 2011 (UTC)

Just to be sure, are you reading the paper or just the abstract? LeadSongDog come howl! 13:40, 2 February 2011 (UTC)

While not usable in the article, this rapid response to that paper is somewhat illuminating. LeadSongDog come howl! 13:51, 2 February 2011 (UTC)

I was reading the abstract. The link for the paper says - "Cummings and White, 10 in their systematic review of 23 RCTs of needling therapies (dry needling or injections), stated that direct needling of MTrPs seems to be an effective treatment, but the hypothesis that needling therapies have efficacy beyond placebo is neither supported nor refuted ... low methodologic quality of original studies... most recent systematic review included 7 RCTs of acupuncture and dry needling for the management of MTrPs.24 Evidence from one study suggested that direct MTrP needling was effective in reducing pain compared with no intervention. Two studies provided contradictory results when comparing direct needling of MTrPs versus needling elsewhere in muscle; the evidence from another 4 studies failed to show that needling directly into an MTrP is superior to various nonpenetrating sham interventions... We agree with Cummings and White's conclusion"

It seems like inclusion in the article should not occur because it is basically reporting that there are no research conclusions and "further research is required", with the latter being an opinion (which I disagree with). That two reviewers have an opinion that more research is needed does not belong in a medical article as WP:Undue (there are many more high end-scientists who think more research is a waste of money). PPdd (talk) 18:03, 2 February 2011 (UTC)

I think you may have missed the point. Your own thoughts, like mine, are irrelevant here, as we are pseudonymous editors and hence our readers should treat us as being both unreliable and unverifiable. We instead must reflect the balance and range of the best quality recent reliable medical sources that we can find on the subject. In this case those sources are essentially telling us that studies to date have had weak methodology and small sample sizes, and therefore the cumulative results have been inconclusive. However, if we can cite a recent high quality review saying that "more research is a waste of money", we should do that too. I haven't found such a source to cite as of yet. LeadSongDog come howl! 19:21, 2 February 2011 (UTC)

You are right that my opinion does not matter. But the existence of an inconclusive review due to poor experimental designs, does not meet standards for inclusion in an encyclopedia, or WP:MEDRS and WP:Undue. And the fact that there are two individuals who think more research needs to be done (especially given a vast majority who think otherwise), does not merit mention in an encycopedia article. Similarly, if every study on astrology was poorly designed, and so a systematic review was inconclusive, yet two researchers said they thought more research was needed, this opinion would not merit mention in an encyclopedia, even with a vast number of poorly designed studies on astrology. PPdd (talk) 20:13, 2 February 2011 (UTC)

The existence of an inconclusive review that does meet the standards laid out in MEDRS (and this one does) is a reliable source for stating "results have to date been inconclusive". I believe that's what it is used for in this article. That's not undue weight IMO since it's not like there is a consensus within the field and this is a tiny minority. We're not noting that there is no correlation or whatever, only that there is no answer yet. The fact is, the question has been examined and the conclusion was we don't know enough to say yea or nay. Though others may think that research may not need to be done, but this opinion is reported as part of a systematic review based on evidence and experiment and not an off-the-cuff opinion. The point is the question is not settled, and the opinion of these two researchers based on their review of the evidence is that it can't be settled - at least not on the basis of the current evidence. That's worth noting.

Astrology is not really a fair comparison since it's not taken seriously by anyone. Acupuncture is taken seriously though whether it is pure placebo or there's something happening independent of placebo is still a question. WLU (t) (c) Wikipedia's rules:^simple/_complex 21:07, 2 February 2011 (UTC)

Agree with WLU and LeadSongDog. --Middle 8 (talk) 16:01, 3 February 2011 (UTC)

"Astrology is not taken seriously by anyone"? TCM and its acupuncture are both based on astrology (see Traditional Chinese medicine on this, and 365 days for for determining location of acupuncture points). Ronald Reagan made presidential decisions based on his wife's astrologer. "What sign are you?" is a serious question for many.

I am still not convinced that putting "studies to date on one aspect of acupuntures many, many claims for types of eficcacies have poor methodologies, and these two people have an opinion as to whether more being done is merited" belongs in this article, or any article, such as astrology. PPdd (talk) 16:40, 3 February 2011 (UTC)

@PPdd: TCM probably *originally* had 365 points based on days of the year, but that number changed over centuries, and about 400 points are taught today in standard TCM courses. Yes, astrology is taken seriously by many, and while articles do note that, WP policy is to give preference to scientific opinion; this is all spelled out in WP:NPOV and related pages. Likewise, it is common for review articles to state the need for further research when the evidence base is small (i.e., lacking in conclusive evidence pro or con). WP's treatment of astrology and acupuncture, respectively, reflect science's opinion of them. Your approach here is becoming disruptive: e.g., changing headers to absurdities; facetious rhetorical questions; WP:IDHT on basic questions of science and WP policy. Most editors don't want to waste time on that level of things. Please see WP:TPG and content policy pages. And if you were going to say you're writing absurdities because you think acupuncture is absurd, your point was taken some time ago. You may remove your rhetorical needle from it now. Thanks. --Middle 8 (talk) 18:17, 3 February 2011 (UTC)

It doesn't matter how many acupuncture points existed in the Chinese system - we're really only referring to the Chinese system at this point, let's not forget there are at least a half-dozen other methods - the point is they have never established a scientific basis for acupuncture points to be taken seriously that I'm aware of. It is verifiable that in at least on peer reviewed opinion, acupuncture's original points were based on a form of astrology and sympathetic magic. Though we should describe the fact that people believe acupuncture points exist, we should also describe the POV that they were historically not based on rational precepts, and that the empirical investigation of acupuncture has not resulted in any specific point being found to correspond to any specific effect. Middle 8, one of your points has long been that acupuncture can't be simply dismissed. Point taken. However, a point that must also be recognized is that after several decades of investigation, the evidence base of acupuncture has become quite narrow, supporting only two columns - nausea and pain. Just because lots of people believe in something, doesn't mean we report that in exclusion to what science has actually found. We should juxtapose the two points whenever possible - "people believe X about acupuncture, but when investigated the evidence base is Y". And generally, that evidence base is not very good. WLU (t) (c) Wikipedia's rules:^simple/_complex 02:33, 4 February 2011 (UTC)

@WLU - you say "We should juxtapose the two points whenever possible" - only to the degree that RS's support doing so. Otherwise, you're grinding your own axe, or in WP terms, engaging in a combination of OR and violating NPOV by giving excessive weight to a synthesis that exists in some places but becomes original when unduly repeated. The evidence base for acupuncture has remained small because of the lack of EBM-gold-standard studies; its direction pro- or con- various conditions has never been striking due to the lack of such studies. The reason such studies are lacking is not for want of effort, but due to the difficulty in controlling for all the variables in the procedure. This is why virtually all Cochrane reviews say that more research is needed. If you are saying that the evidence base is consluviely negative for a number of conditions, you are on a different page than Cochrane reviewers. Your view is on the skeptical side of a spectrum of views; it should not be taken as the only one. --Middle 8 (talk) 07:55, 4 February 2011 (UTC)

If two reliable sources note two points that are polar opposites, we should note both. If multiple reliable sources converge on a point with a small number dissenting, we note both but give more weight to both. In acupuncture, there is plenty of criticism, few high-quality review and meta-analyses saying anything good, and a lot of theory inherited from tradition. All of which we note. And we also note that in most cases, the reviews are inconclusive - acupuncture, in a well-controlled experiment, normally produces no effects beyond placebo. The exceptions are pain and nausea. The best studies I've seen all discuss this, and this is what the page says. The fact that practitioners want to believe in magic (i.e. the "methodology" of acupuncture) is noted, but the evidence must also be noted. This is why we keep arguing over the use of "pseudoscience". The methods of acupuncture are nonsense, little more than wishful thinking and folk reasoning you can find in any culture. The results do have some evidence - for pain and nausea. Little more.

The characterization of the actual evidence base for acupuncture has been steadily narrowing - this is discussed in Trick or Treatment. As controls got better, the evidence supporting acupuncture got worse. That's noted in the last paragraph of the section on evidence-based medicine. WLU (t) (c) Wikipedia's rules:^simple/_complex 12:29, 4 February 2011 (UTC)

There is no general agreement that controls have gotten better. They have changed, yes: generally in the direction of reducing false positives while increasing false negatives. --Middle 8 (talk) 21:10, 4 February 2011 (UTC)

Edit to lead

Note that I've removed some material from the lead. There are a couple problems with the edit in question.

The source used is a primary source aimed at evaluating the effectiveness of a specific intervention on a specific group. Per WP:MEDRS, primary sources should be used with caution and only to substantiate essentially the main point of the primary source. In order to propose a mechanism, particularly in the way proposed in the removed section, a review article or scholarly book from a well-respected publisher should be used.
The specific wording used makes it sound like the article specifically addressed acupuncture's effects on pain and nausea via this mechanism. Even if the introduction or discussion section made these points explicitly, this is still a primary source. The wording was very, very original research-sounding to me, synthesizing several citations to make a specific conclusion. Difuse noxious inhibition of stimulus is one potential mechanism through which acupuncture works, and the science is not settled. There are many strong opinions and we should not be depicting the discussion as if it were settled.
On a purely technical level, we should be citing the pubmed link and using a citation template (that's not really technical, but it matches the sourcing to the style of the rest of the page). If this article is replaced in the page (which I would strongly urge it not be, for any reason), we should use a citation template. I would suggest {{cite pmid | 16618043 }} since it's pretty much the fastest way to include pubmed-indexed articles. It autofills the citation and therefore avoids things like saying this is a "ham-controlled trial", an incredibly amusing typo On another technical note, we should have used the <ref name = whatever> tags to cite this article twice, not repeating the same citation. PPdd, for that sort of stuff feel free to ask me or any other experienced editor about those sorts of tricks. That's not a big deal at all, it's just something you have to see a couple times to know how to use.

Keep in mind this is coming from an editor that thinks acupuncture is utter shit - this edit was against my personal POV, that's how damned strongly I feel about it. A good article that will be defended by everyone interprets the P&G fairly for all sources and edits. I notice the article has been used elsewhere in the page, I plan on looking at it there as well and expect to re-remove it.

The other edits I have no problem with so far, they do remove a lot of unsourced information which is perfectly valid per WP:PROVEIT. Having fresh eyes on a page helps clean up stuff like this and usually leads to new, more reliable sources being added. WLU (t) (c) Wikipedia's rules:^simple/_complex 17:17, 4 February 2011 (UTC)

Your removal of my primary source material was appropriate. PPdd (talk) 17:41, 4 February 2011 (UTC)
The remaining lede still makes it look like acupuncture's trivial effectiveness for nausea and pain is a big part of acupuncture (WP:Undue), that it has a strong effect when it is very minor, that this effect is inexplicable or surprising enough to merit mention in the lede (one would expect sticking needles in a body would cause release of the body's natural pain relievers, just as in tattooing), etc.

I deleted not only NRS proPOV material, but also NRS antiPOV material. I delete all NRS stuff everywhere I see it if I do not already believe it, and add a cit needed tag if I do already believe it, no matter what my POV. One thing I deleted was a reference to acupuncute causing nausea, but the source cited only had a last name, Cheng, and date (1987?), with no title, full name, or way to check it. This directly contradicts that acupuncture treats nausea.

So I suggest removing the nausea and pain specifics from the lede (using these reasons and MOS "no specifics inthe lede", WP:consistency, and WP:Undue), but leaving it in the body.

I will read up on citations and referencing and ask you if I can't figure it out without wasting your time on me. Thanks for the offer.
I am not convinced that acupuncture is utter shit. (You can get rid of shit by flushing the toilet, but not acupuncture.) More seriously, I believe that it might be possible to relieve larger pain by causing smaller pain (e.g., by causing release of natural pain relievers or by distraction. In grad school, I was dating a psychology grad student who studied cognitive coping strategies and their effects on the immune system under Linus Pauling in his last years, and her study is still carried out by at UCSF dental school 15 years later, where you can get free dental care by foregoing anasthetics - gotta be some poor people out there somewhere to experiment on.) I try to balance radical skepticism with radical open-mindendness. I know people with tattoos who like getting them, because, they say, it causes a state of euphoria. (Don't you just love people who italicize every other word?) PPdd (talk) 18:13, 4 February 2011 (UTC)

Wasn't Pauling a nutter basically after 1975?

If we want to indicate that acupuncture's effectiveness is trivial (something I'm not convinced of, the placebo effect can be quite strong, even if it is transitory - and that assumes acupuncture is nothing but a placebo effect which is still up for debate irrespective my thoughts on the matter) then we need a better source. I would agree to such a commentary given an appropriate source, but sometimes we have to live with stuff like this pending new research and review articles. Wikipedia is not done so no need to come to a conclusion. Remember, the lead is meant to be a broad overview, and we should only note that acupuncture's effectiveness is "trivial" if there is strong indication that this is the scientific mainstream opinion - I don't think it is. That acupuncture is effective for pain and nausea should remain in the lead in my opinion, particularly given the sources. I don't know if it's worthwhile to parse the sources to determine whether they give an indication of how effective.

I really don't mind giving suggestions on referencing, templates, tables and the like, it's one of the more gratifying parts of editing a collaborative work. If you are planning to be here for a while, you really need to know about diberri's template generator, particularly with a pubmed number or ISBN. The pubmed template generator is particularly useful if you plan on editing anything that's medicine or biology-related. You can also look into adoption or editor assistance for quick replies to specific questions. {{Helpme}} is also a handy template to use if you need a quick reply. Oh, and don't try to use an ampersand in your auto-signature. Doesn't work. WLU (t) (c) Wikipedia's rules:^simple/_complex 18:24, 4 February 2011 (UTC)

Nutter? Yes. But he had the best free immunology lab near Stanford in the early 90's. I owned the building across the street from it (where Hewlett and Packard first started up) then. I was also doing philosophy of data analysis at the time, and after talking to all his grad students and post docs about his Vitamin C studies and claims, he ended up banning me from his building. PPdd (talk) 18:32, 4 February 2011 (UTC)
I think acupuncture's effect is beyond (unpainful) placebo, due to release of the body's pain inhibitors from its painfulness (whether conscious pain, or a body response to trauma). I don't think it is merited in the lede, however, or at least without huge qualifications. The nausea thing definitely does not merit lede placement, especially as this is not consistent with the partially sourced material I deleted. PPdd (talk) 18:36, 4 February 2011 (UTC)
There is a strong "moving goalpost" thing going on in the article, or implied by its wording. Acupuncture is found to have some effect for pain, but this is often used to imply that acupuncture has an effect, in general, as in "56 % of doctors think acupuncture works". Also, there is a shift between using "acupuncture" to describe reandomly sticking needles, vs. "acupuncture" as sticking only in "12 rivers/365-days" points, then shifting back again. Doing a correct study is very ethically problematic, because the "victim" of the study is being offered two painful placebo treatments to "relieve" pain. PPdd (talk) 18:45, 4 February 2011 (UTC)

Will it hurt?, and "death by acupuncture"

I have a childhood based fear of doctors with needles. Does acupuncture ever hurt? PPdd (talk) 03:26, 2 February 2011 (UTC)

Wikipedia is not a how-to manual and does not give advice. If you can find a reliable source discussing this, it's probably worth adding to the aritcle but wikipedia editors aren't the kind of people to ask about this sort of thing. WLU (t) (c) Wikipedia's rules:^simple/_complex 20:42, 2 February 2011 (UTC)

I couldn't find RS. But it would be information about acupuncture. Tatoos hurt and cause bleeding. Does acupuncture? Does deep dry needling of Mftp? Maybe someone else has RS on this. PPdd (talk) 20:48, 2 February 2011 (UTC)

Read Singh and Ernst's book Trick or Treatment. Acupuncture is not "harmless". Injuries and at least one death have been linked to it. Famousdog (talk) 12:16, 3 February 2011 (UTC)

Death by acupunctue? What a way to go. I think I will expand this section header. (I always wondered about what kinds of historic experiments on people might have led to acupuncture's development.) PPdd (talk) 14:10, 3 February 2011 (UTC)

An Austrian patient was killed when a needle penetrated her sternum and pierced her heart. Minor infections from dirty needles are common. Hepatitis and pneumothorax are a potential risk. You say you're scared of needles? Then expect side effects related to anxiety such as nausea, vomiting, fainting, etc. The biggest lie in all creation is that alternative medicine is "harmless rubbish". Its not. Rubbish? Yes. Harmless? Not necessarily. Famousdog (talk) 14:30, 3 February 2011 (UTC)

Rubish? Rubish is usually easy to get rid of. Don't overrate acupunture by equating it to the much more manageable "rubish". PPdd (talk) 16:27, 3 February 2011 (UTC)

You made the exact same observation above about "bullshit". Repetition of a triviality that is not germaine to the article wastes space and other editors' attention. Kindly stop, per WP:TPG and WP:POINT. --Middle 8 (talk) 18:28, 3 February 2011 (UTC)

(undent) I'm an acupuncturist with a previous career in pharmaceutical research. Information needs to be considered in context; some drugs that are considered safe enough to sell without a prescription are far more dangerous than acupuncture (tylenol, for example). Even aspirin kills a few people each year; the total of 86 reported for acupuncture (over every year of recorded history!) is thus relatively quite low. Bicycles and soccer balls are far more of a menace. Compared to virtually all drugs and therapies, acupuncture is quite safe [1]; the references in the article all support that conclusion. How well acupuncturists are trained makes a huge difference: in the U.S., for example, they receive thorough education on safety (including all the issues mentioned above) and are required to use sterile, one-time-use, disposable needles in almost every state. Middle 8 (talk) 15:58, 3 February 2011 (UTC)

I am no big fan of pharmaceutical industries and surgeons pushing their products to line their pockets, so this does not argue for acupuncture being harmless. PPdd (talk) 16:27, 3 February 2011 (UTC)

(Note: Please don't break up other editor' comments; again, see WP:TPG.) As I said, the issue is one of relative risk. --Middle 8 (talk) 18:25, 3 February 2011 (UTC)

As for pain, just google; acupuncture needles are much smaller than hypodermic needles, and generally don't "hurt" as much as cause a "twinge" initially which then fades into a pleasant, relaxing feeling. The large majority of the time, the places in the body that were needled don't even bleed when the needle is removed. Just tell your acupuncturist if a needle hurts too much, and she'll remove it and insert another in a slightly different position. No two people are exactly alike, and some may have small nerves near the skin that are too close for comfort to the textbook point location. --Middle 8 (talk) 15:58, 3 February 2011 (UTC)

So it does sometimes hurt? I googled, but just got NRS stuff, and it was all about relieving pain, not causing it. Can you point me to RS on this? PPdd (talk) 16:27, 3 February 2011 (UTC)

See, this is another example of a facetious rhetorical question that wastes time. One might as well say "hey, surgery is supposed to relieve pain; why do they have to use anesthetics then, HUH?". For RS, see "Contemporary Chinese Medicine and Acupuncture" or any book on delivery of acupuncture care, or, if you like, patient FAQ from professional organizations such as the AAAMA. Just google. And anyway, where is RS needed in the article? --Middle 8 (talk) 18:25, 3 February 2011 (UTC)

Its not a facetious question. I can't get a straighforward answer to it. I would never get a tattoo if only because of the pain. Acupuncture makes ridiculous claims about "healing", totally unsupported by any study. And undergoing pain for what is at best a barely detectable effect according to ALL studies makes not sense. Can it be painful and cause bleeding? PPdd (talk) 18:48, 3 February 2011 (UTC)

Note that many people may die from taking aspirin or tylenol. That should be appropriately noted on those pages. Note that people have died from acupuncture, that should be noted here. Note that tylenol and aspirin both have well-established risks, and unequivocal benefits. Note that acupuncture has well-established risks, but its benefits are far, far more questionable. That is the difference, and that is why there is such debate on the topic. Acupuncture points have never been reliably demonstrated to correlate to any meaningful anatomical structures, nerves or otherwise. As for this being a good example of something, this section is a good example of a large number of talking points and a few sources (only one). So my ultimate comment is - if you want to include information about acupuncture being painful, look for a reference on it. Try google books. All this discussion is giving Middle 8 a platform to repeat him/herself, and wasting a lot of time. Sources people, sources then content. If it's a review article or reliable book, it's valid for inclusion. If the point has been criticized in the same, it's also valid. We are not a forum for discussion. PPdd, I answered your original question in a manner appropriate to a wikipedia talk page - we shouldn't try to establish the truth of whether acupuncture hurts, we should establish if the sensation of acupuncture can be verified. Stop baiting each other. WLU (t) (c) Wikipedia's rules:^simple/_complex 02:42, 4 February 2011 (UTC)

@WLU: your complaint that I repeat myself on this talk page is about as striking an example of WP:KETTLE as any I've seen; the evidence is right there in the edit history. --Middle 8 (talk) 07:58, 4 February 2011 (UTC)

That would sting a little more coming from someone who wasn't a SPA and equally guilty. I will note, however, that I have supported a referenced methodolgy and history section, and that the best sources tend to support my points. WLU (t) (c) Wikipedia's rules:^simple/_complex 12:33, 4 February 2011 (UTC)

@WLU - yes, I know; only on Wikipedia is it considered bad to volunteer in one's own area of expertise. Have fun keeping this PPdd guy in check. It would be funny to let him just write whatever he wants, though, wouldn't it? --Middle 8 (talk) 10:03, 5 February 2011 (UTC)

I am not intending to bait anyone. I just wondered if it hurt. I don't think my question has not been asked by almost enyone who ever got acupuncture, so it is certainly article material. The problem I had with RS on this was that searches for "pain" produced "pain relief references. I was hoping someone might already have RS on this. I don't even know who Middle8 is. I agree with "many people may die from taking aspirin or tylenol. That should be appropriately noted on those pages", but add it should also be noted on the box of the product. The blight of overprescription and overuse of pharmaceuticals and surgeries is terrible. PPdd (talk) 03:01, 4 February 2011 (UTC)

WLU, thank you for taking the time to track down a source, but it is not MedRS. It is not peer reviewed and says, for example, “modern science has measured the electrical charge at these (acupuncture points), corroborating the locations of the meridians.” I will use your (implicit) idea of using "painful" instead of "pain" at google scholar. PPdd (talk) 03:17, 4 February 2011 (UTC)

Books are perfectly acceptable sources for even medical opinions. MEDRS does not apply blindly to the entire page. For basic information like "what does acupuncture feel like" we don't need a Cochrane review. Further, I wouldn't expect it. There's a reason I went to google books for this. The fact that it is published by Cengage Learning, an academic publisher, means it is reliable enough. However, the fact that it makes blanket statements that better sources do not support means I would suggest not using it for that purpose. But it's fine for "acupuncture normally isn't painful".

The blight of modern pharmaceuticals and overprescription is terrible, but irrelevant for this page except to note that it is used as a red herring to validate the use of acupuncture. And in that case, only if a reliable source makes the point for us. If you want warnings for acupuncture to appear on a box somewhere, you're in the wrong place. We're an encyclopedia, not a soapbox, crystal ball or publisher of original research. If you're really interested in how acupuncture feels, play around with some search terms and dig a bit in google and google books. You don't need an international review panel to note that acupuncture has been described as painful, odd, warm, electric, numbing or whatever - you just need a source that doesn't say something outrageous. This would be fine, so would this one. We're not talking about heart transplants, it's a fine needle being stuck into the body. If that's our substantive concern, I think most people would agree to something said in one of these sources. WLU (t) (c) Wikipedia's rules:^simple/_complex 03:35, 4 February 2011 (UTC)

Thanks again. I found MEDRS for “acupuncture is a painful and unpleasant treatment”^[1] using google scholar. But this opens up a can of worms as to how acupuncturists hide this information so well. I also found MEDRS that twisting the needles is extremely painful. An endorphin release that relieves a headache would be expected in such cases, not be surprising. I am still looking. PPdd (talk) 03:43, 4 February 2011 (UTC)

"Two patients terminated study participation, complaining that acupuncture was too painful to continue." [2]
"acupuncture is a painful and unpleasant treatment" [3]
"Japanese acupuncture needles are much finer than their Chinese counterparts, and hence far less painful." Acupuncture Today, Southern Medical Journal, July 1988 - Volume 81 - Issue 7 - ppg 885-887, Yasuo Yshida
"For the purpose of pain relief, the choice of non-acupuncture points as a sham treatment is also a problem because of the existence of diffuse noxious inhibitory control (DNIC) phenomena; it is well established that painful stimulation inhibits pain, and DNIC has been proposed as a physiological basis of acupuncture analgesia." [4]
PPdd (talk) 04:38, 4 February 2011 (UTC)

(outdent) The best source for adverse effects in acupuncture (including pain from needle insertion) is this Ernst review, which puts the total number of adverse events at 11.4% and notes that they are mostly minor. PPdd, you could have found this by reading the article. --Middle 8 (talk) 08:01, 4 February 2011 (UTC)

This review of acupuncture you refer to , is only about acupuncture at points used to treat pain and only in Germany for that, and does not discuss how painful it is during treatment (in the abstract on the linked page you provided). You still have not answered my question in a straightforward way, does it hurt? It seems like there must be an attempt to cover this basic question. In fact, as far as I can tell, any minimal nonplacebo effect observed is thought by scientists to be a result of the body's DNIC reaction to the painfulness of treatment. PPdd (talk) 13:32, 4 February 2011 (UTC)

PPdd, that represents original research. If you want to know if the "jamming the needle in" part of acupuncture hurts, you've got your answer - it can, but a variety of sensations are reported. Middle 8, PPdd's original question was about pain. Ernst's review of adverse events should be included as well. Though pain should be noted, so should the fact that it doesn't always hurt and a variety of sensations have been reported. That's about it. WLU (t) (c) Wikipedia's rules:^simple/_complex 12:33, 4 February 2011 (UTC)

I don't understand how quoting three MEDRS on a talk page is OR. From WP:OR - "To demonstrate that you are not adding original research, you must be able to cite reliable published sources that are both directly related to the topic of the article, and that directly support the material as presented." I have not even yet proposed content. Apparently the practice varies widely worldwide and the painfulness level varies with practitioner, the level of pain depends on where the needles are inserted for different treatments, the level of painfulness ot treatment varies with how the needles are manipulated, some people do not mind or get used to the pain of insertion, some people do not mind or get used to the pain of manipulation, and some people find the pain intolerable. A futher question is whether it hurts more for 1st timers, as compared to people who have developed a tolerance for it over their life. This is discussed in another clearly MEDRS article I found. PPdd (talk) 13:26, 4 February 2011 (UTC)

Note that "painfulness of treatment" is different from "adverse effects" as commonly used. For example, getting an injection of morphine in one's buttox may be painful, but it is not listed as an "adverse effect" of morphine (which has plenty of adverse effects: addiction, constipation, etc.). The pain in treatment is likely responsible from the minute effects detected via the diffuse noxious inhibitory control (DNIC) phenomena, as speculated in the source above. PPdd (talk) 14:51, 4 February 2011 (UTC)

Three sources synthesized on the talk page is OR, but it doesn't really matter since OR is only an issue on the actual main page. On the talk page it falls more under misuse of the talk page (which we've all been doing for quite a while). So long as you don't port these sources and their conclusion to the main page, it's not really an issue. This is still a synthesis ("acupuncture is painful") because none of the sources focus specifically on whether acupuncture causes pain. We're better off citing sources which discuss the myriad ways acupuncture can feel. Clearly it is not a unitary sensation or phenomenon. That getting stuck with a needle is painful falls under the heading of "well duh" but the fact that it is consistently described as something other than painful is something worth noting. Certainly we should not push the POV that acupuncture is just painful without a convergence of sources on the topic. WLU (t) (c) Wikipedia's rules:^simple/_complex 18:33, 4 February 2011 (UTC)

Cheng citation

I notice references to Cheng are being removed (i.e. [5]). This is debatable. Though only "Cheng, 1987" is given, this is still a valid, if imprecise source. When the reference number is clicked on, it takes you to the reference itself. This reference should be hyperlinked to take the reader to the "References" section, specifically the line with Cheng, 1987 on it (Cheng, X (1987). Chinese Acupuncture and Moxibustion (1st ed.). Foreign Languages Press. ISBN 7-119-00378-X.) If the google books link had a preview I'd link to this.

I don't know how reliable the book is for medical claims, but for basics of Chinese acupuncture (number of points, meridians, typical treatment, etc.) it is probably adequate.

Remember that while all information should be sourced, commonly-accepted knowledge or knowledge no-one objects to does not need a citation. We don't need a refernce after the sky being blue, the capital city of a country, the roundess of the Earth or that cancer is conventionally treated with chemotherapy and surgery. The big flaw in many sources is the lack of page numbers; that could be addressed by finding the page numbers in the original text. Probably easier would be finding the same information in another source - for instance, this one which has a preview option and allows for searching inside. Though further references are invariably a boon to the page, removing unsourced information is not always the best action to take. If the information is basic (acupuncture involves needles; acupuncture exists in China) then wikipedia and our readers are not helped by removing this sort of thing. I'm not saying replace all the information and references, but be judicious and ask if the information removed really needs a source, and if the page is better for even unsourced information being present. WLU (t) (c) Wikipedia's rules:^simple/_complex 19:42, 4 February 2011 (UTC)

I would have tried to improve the ref, but the material seemed to make medical claims, e.g., that acupuncture (always) causes nausea and (always) cures headaches, which seemed inconsistent with other material in the article, like relieving nausea. What do you think on these points? PPdd (talk) 20:06, 4 February 2011 (UTC)

You removed a lot of stuff, I don't recall seeing Cheng refer to pain and nausea specifically. For pain and nausea, I would definitely suggest using better quality, more recent sources rather than Cheng. For basics of acupuncture however, I would think it's fine.

Note that even conventional, well-proven medication does not always cure whatever it is prescribed for, so that's a bit unfair. Acupuncture has, to the best of the ability of research to tell to date, been proven to improve pain and nausea. It's still not perfect, it could still be placebo, this is noted, but we shouldn't be unfairly critical. WLU (t) (c) Wikipedia's rules:^simple/_complex 02:09, 5 February 2011 (UTC)

Here's the Cheng material I deleted -

"In the clinical practice of acupuncturists, patients frequently report one or more of certain kinds of sensation that are associated with this treatment:
Extreme sensitivity to pain at the points in the webs of the thumbs.

In bad headaches, a feeling of nausea that persists for roughly the same period as the stimulation being administered to the webs of the thumbs.

Simultaneous relief of the headache.^[2]"

I would have tried to check the ref, but it was 1987, and totally incosistent with a claim of nausea relief. I outlined this problem below, where "acupuncure" keeps shifting meaning, e.g., treatment for nausea may cause pain, and treatment for pain may cause nausea. But both treatments are called "acupuncture". So (assuming it actually has efficacy in both), does it cause or relieve nausea? The logical error causing the problem is called the fallacy of four terms.

I have a big problem with medical articles that claim efficacy without saying HOW effective. For example, if Rogaine was 100% effective at growing ONE hair, it would be called '100% effective", and people who buy it would still get about nothing. Similarly, even if there was endorphin release from needling, does the needling cause more pain than it relieves? All these are important questions which seem to be ignored. (They get deliberately obfuscated like this by pharmaceutical companies, too.) PPdd (talk) 02:22, 5 February 2011 (UTC)

Moving the goalpost definitions of acupuncture, and recommendations that "more studies are needed" - in this article

This article uses fallacy of four terms reasoning in that it is constantly shifting definitions of acupuncture to imply false things.

"Acupuncture" defined as "12rivers/365days acupuncture" is compared to "randomly sticking needles" as placebo;
Then "randomly sticking needles" is called "acupuncture" to compare to "nonpenetrating needles" as placebo.
Then "acupuncture" is comared to no treatment, as "control", with it being left unspecified as to which "acupuncture" definition is used.
"Acupuncture" definition is then broadened include "stimulation without needles", e.g., in the NIH nausea relief claim, which concludes that "noninvasive stimulation" of one of 365 points is the same as sticking in needles, and it is said that there is evidence that "acupuncture" relieves nausea (even though no needles are needed.
The concept of "point" (which occupies zero area) is never defined, leaving "an area of unspecified nearness to one of 365 points" stimulated to be a new definition of "acupuncture points".
Then some version of one of these "acupuncture" definitions is found to have some efficacy for pain or nausea relief, without specifying which definition of acupunture, or whether there was a placebo or "control" used for the conclusion.
Then "acupuncture" is declared effective, even though only one of the various "acupuncture"s may have had efficacy, as if this shows efficacy for all definitions of acupuncture.
Then "12rivers/365days acupuncture" is declared effecitive because "acupuncture" is, and implicit in declaration is that 12 rivers and 365 days has to do with efficacy!!!
Then "accupuncture", without specifying which definition is used, is said to relieve nausea.
Then "acupuncture" is said to relieve headaches, but cause nausea. (Cheng 1987 entry)
Then poor placebo construction leads to meaningless systematic reviews, which thus conclude "more research is needed to reach conclusions", which is then changed to "the review says more reasearch is needed", to imply they are reccommending wasting still more money on studies!
Then these various definitions and ambiguities are combined to create still greater ambiguities.
An example of this abuse is WHO findings, which do not even compare to placebo in some cases. Another example is findings by bodies about pain relief when compared to no treatment, then concluding a statement about "acupuncture" in general, under which definition not being specified.
This violates the basic "consistency" requirement at WP, e.g., as stated in MOS.
A result is an article that reads like an advert for "acupuncture".

This article needs alot of work! PPdd (talk) 16:28, 5 February 2011 (UTC):Not a bad start on a todo list, though by neglecting to provide links you've left your meaning rather ambiguous. I've added a {{todo}} at the top of the page, I'd suggest moving these points there so they don't disappear into talkpage archives before they're addressed. After that, I'd suggest you add links to clarify the article sections you are referring to at each point. LeadSongDog come howl! 22:39, 4 February 2011 (UTC)

I will start cleaning up the article, e.g., starting with AMA. The AMA was very critical, calling acupuncture "astrology based".[6]. The article says "the American Medical Association (AMA) Council on Scientific Affairs produced a report in 1997, which stated that there was insufficient evidence to support acupuncture's effectiveness in treating disease, and highlighted the need for further research."[7]. What they really did is say, not that there was such a need, but http://www.ama-assn.org/ama/no-index/about-ama/13638.shtml [Much of the information currently known about these therapies makes it clear that many have not been shown to be efficacious. Well-designed, stringently controlled research should be done to evaluate the efficacy of alternative therapies.”]", i.e., if you want to waste your money on a study, then at least do the study correctly". Quite a shift of meaning, with similar shifts repeatedly done. PPdd (talk) 23:16, 4 February 2011 (UTC)

I added the list to the "to do" list at top, but comments on how to fix all of this should go in this section. PPdd (talk) 16:28, 5 February 2011 (UTC)

NIH, politic milk-toast, or junk science?

The NIH, with appointments made by political considerations, has always blended milk toast political caution with science, as its director is a political appointment, not a nomination by peers.

But in the report cited in the article, it ventures into pure junk science futurology It made findings that can only be classified as being pseudoscientific futurology, making predictions about what “future” studies in areas not yet tested will “likely” uncover - =

“Further research is likely to uncover additional areas where acupuncture interventions will be useful.”

One wonders what statistical methods they used to conclude “likely”, given that the areas referred to have not been tested. Shame, shame. PPdd (talk) 23:58, 4 February 2011 (UTC)

None the less, it is still a widely-respected organization and a reliable source. It should be included, and only criticized if a reliable source can be found. WLU (t) (c) Wikipedia's rules:^simple/_complex 01:59, 5 February 2011 (UTC)

Unfortunately, I agree. PPdd (talk) 02:00, 5 February 2011 (UTC)

Claim of nausea reduction "noninvasive acupuncture"

The cochrane study cited says

"There was no clear difference in the effectiveness of P6 acupoint stimulation for adults and children; or for invasive and noninvasive acupoint stimulation."

So invasively sticking needles in someone had no extra effect. The lede says otherwise. "Noninvasive acupuncture" is oxymoronic. This is another case of moving the goalpost defining acupuncture. PPdd (talk) 15:15, 5 February 2011 (UTC)

"Efficacy" findings are misleadingly stated in article

The "efficacy" findings are misleadingly stated in article. The article does not state "how much" pain relief, even if there was 100% pain relief. Using another example, if a remedy for baldness caused one hair to grow 100% of the time, it would have 100% efficacy, but be useless. Similarly, if sticking needles into someone always caused a very minute amount of the body's natural pain relievers to be released, it would have 100% efficacy, but be worthless. PPdd (talk) 21:02, 5 February 2011 (UTC)

What? Why can't they design a good experiment?

"One of the major challenges in acupuncture research is in the design of an appropriate placebo control group."

Am I the only one who finds this to be a silly statement? It would be EASY. 200 people with kidney problems (or some other problem over which acupuncture claims efficacy and is not obvious by simple observation.) The patients are seated in the room and the acupuncturist walks in and treats the patient. Half the time the acupuncturist is told to treat kidney problem and half the time he is told to treat something else (placebo.) They aren't allowed to speak so the acupuncturist does not know what ailment the person truly has and the patient does not know acupuncture so he doesn't know what is really being treated. This is a perfectly double blind experiment, is it not? Then the patients rate the efficacy of the treatment (or it is measured scientifically if possible). You compare the percentages of success of the real treatment and the placebo. Easy experiment design, right?

The truth is that these kind of experiments have been done, but acupuncture does not usually fare well - most of its claims do not hold up in scientific study while a fraction seem to. Like most pseudo sciences, rather than roll back their claims when confronted with science, they attack the scientific method or claim that it doesn't apply. For years, ESP people have claimed that they can't perform in labs because of electrical fields and psychics claim they can't be tested because of the negative energy of the testers. Similarly, acupuncture is trying to claim that it can't be tested because it can't fit into basic experiment design.

"In trials of new drugs, double blinding is the accepted standard, but since acupuncture is a procedure rather than a pill, it is difficult to design studies in which both the acupuncturist and patient are blinded as to the treatment being given."

Again, ridiculous - countless medical procedures are tested every year. This just sounds like a closed tautology speaking. —Preceding unsigned comment added by Ksjazzguitar (talk • contribs) 18:25, 28 September 2010 (UTC)

You may find more details in the references appended to that statement, but this is a good popular summary that touches on some of the issues faced. Designing a good placebo for acupuncture is actually quite difficult - altering the points needled addresses only one aspect of what "acupuncture" incorporates, and you also have to distinguish between "acupuncture", "dry needling" and "Traditional Chinese medicine" - each is a separate test. You have to control for nonspecific affects - the acupuncturist's own beliefs, which can leak through body language, duration of treatment, care, etc. Many systems of acupuncture claim a need for a lengthy diagnosis based on the TCM approach, and practitioners will claim it's not "real" acupuncture if you don't spend an hour taking pulses, interviewing, looking at the tongue, etc. Designing a test of "verum" acupuncture is actually quite tricky for many, many reasons - location of the needles, modality, whether electricity is used or not, whether the skin is penetrated, etc. I would suggest Trick or Treatment as a good place to look into this, but there's lots of places where this kind of thing is discussed - I like Sciencebasedmedicine.org and Respectful Insolence. Snake Oil Science is also a good book that focuses on methodology.

But as far as this page goes, talk pages are not meant to be forums for discussion. We base the page on a neutral summary of what reliable sources say. And one of the big criticisms of acupuncture is that it is actually quite difficult to do a fair test of "real" acupuncture rather than placebo and expectation effects. That's pretty easy to verify and therefore should remain - if you find the point confusing after reading the lead and body text on this topic, that suggests we need to do a better job of explaining it though. WLU (t) (c) Wikipedia's rules:^simple/_complex 18:50, 28 September 2010 (UTC)

The paradox with acupuncture, is that in most trials the acupuncture fairs no better than the placebo, but for a limited amount of conditions, when the acupuncture is combined with some conventional therapy, then it performs better than the conventional therapy alone. Wilfridselsey (talk) 19:04, 28 September 2010 (UTC)

What's the difference between "true" and "sham" acupuncutre really? Basically the system of TCM behind it. The fact that "real" and "sham" acupuncture produce the same response should be taken as a substantial indication that the theory behind it - qi, meridians, Blood, etc. - are essentially worthless and it is the process of stabbing people with needles that is effective. It doesn't matter where you stab them, it doesn't matter if you really use needles (versus toothpicks, or retracting needles that don't pierce the skin), what does matter is that the person believes they are being stabbed and that it is effective. The next step to take is to try to tease out whether the actual stabbing with needles is worthwhile, or if it's also useless. If stabbing people with needles has a true effectiveness beyond placebo and expectation, you should still see an effect when you have a well-designed trial that controls for all variables except "skin penetration". They've managed to do some of those trials by modulating the demeanour of the therapist (higly suggestive that acupuncture is effective versus a very neutral practitioner) and found that the more enthusiastic the practitioner, the better the results. This is highly suggestive of a placebo effect. When you combine acupuncture with actual medical treatment, it's very, very arguable that all you are adding to the treatment is a strongly suggestive placebo effect - particularly since it is an unusually effective placebo as it combines theatricality (needles!), exoticness (from the mysterious Orient!), injections (needles again!), nonspecific effects (lengthy diagnosis interview!) and expectation (newspapers love this shit and report positive studies all the time with nary a mention of alternative explanations!) into a single dramatic package. Ben Goldacre has some neat stuff on this [8]. The fact that "real" and "sham" turn out to be very, very similar in effectiveness, irrespective of the type of sham (varying location, retracting needles, toothpicks, fake TCM theory) reinforces the idea that acupuncture could very well be nothing more than a form of autointoxication via endogenous opioids or a redefinition of pain by the CNS. This is further reinforced by the fact that the two symptoms it is most effective on - pain and nausea - are both subjective events that are among the most susceptible to the placebo effect. Meanwhile, it's pretty much useless for drug withdrawal, smoking cessation, weight loss and actual treatment of any disease. The fact that "true" and "sham" acupuncture are indistinguishable in results is highly suggestive of the idea that there's no real benefit to acupuncture itself, merely that the ritual is effective at evoking natural pain-relieving and pain-redefining mechanisms. WLU (t) (c) Wikipedia's rules:^simple/_complex 19:27, 28 September 2010 (UTC)

Probably, the most interesting experiments are those using functional MRI. They stick a needle in and see what reaction there is in the brain essentially, this one is probably closest to your 'kidney problem scenario: [9] Wilfridselsey (talk) 19:55, 28 September 2010 (UTC)

I don't understand the excitement at the finding jamming needles into a person lights up an MRI. If I'm reading the study correctly, the sham acupuncture point, at a part of the body far less sensitive to stimulation than the hand, didn't light up the same areas as the "true" acupuncture, and either didn't light up any areas at all ("Nor did it elicit any other activation or deactivation detectable at this threshold") or did light up a different area and they didn't report it ("In addition, activation was detected in the medial frontal gyrus"). It would be interesting to map these points to the Cortical homunculus, where the distance between the finger and wrist is, neurocortically, far further apart than it is in the body. The difference in saliva production is also statistically significant, but I wonder if it is clinically significant? And it's hardly a wonder that presenting an irritating stimuli causes the mouth to water. Results like this would be suggestive, but they're not, in my mind, paradigm-breaking by any means. WLU (t) (c) Wikipedia's rules:^simple/_complex 20:43, 28 September 2010 (UTC)

Primary somatosensory cortex homunculus, anybody?

The upper lip of the lateral sulcus, an inch or so either side of the central sulcus, is called the Rolandic operculum. The swallowing section of the primary somatosensory cortex (S1) is located in the portion of the Rolandic operculum posterior to the central sulcus. S1 is green in the top left image here. As you follow that cortex into the lateral sulcus, it becomes part of the ceiling of the lateral sulcus, embodying the secondary somatosensory cortex (S2, green in the top right image). The (brown) wall at the end of the lateral sulcus is the insula. Sorry if that's too much information.

If the real acupuncture activated the Rolandic operculum, as the authors report, that is spooky. The Rolandic operculum on the outer surface is normally not involved in generic pain processing, so it's not an artifact of that. Actually, on further thought, the "swallowing" section of S1 is adjacent to S2, and S2 is active in both hemispheres in response to oddball somatosensory stimulation. [10] So the activity located in the Rolandic operculum in this study could simply be S2 registering the shift of attention to the sensation. All depends on the precise location of the activity, I guess. But if that's what is happening, it doesn't explain the lack of activity in the sham punctures, which would have been equally oddball. I give up. Anthony (talk) 22:13, 28 September 2010 (UTC) Addendum. 05:50, 29 September 2010 (UTC)

Note - I put in my tongue map request in the section below before reading this section. PPdd (talk) 15:20, 8 February 2011 (UTC)

I think that the studies using fMRI on humans and animals have been the most interesting. A lot of the studies into acupuncture have been subject to the Hawthorn effect. fMRI

apparently gets round that, although not all results have been as clear cut as this particular one. Wilfridselsey (talk) 07:14, 29 September 2010 (UTC)

Considering the Hawthorne effect is a mental reaction to a situation, I don't see how an fMRI would get around it since the brain does the thinking. But irrespective, what is needed to include this information in the page is a secondary source. Brain imaging is mentioned here but a newer study would be better. I've looked on pubmed but the abstracts are pretty vague and more than a little gushy. It'd be interesting to see what happens when a skeptic looks at the same data. I'll look a bit more on pubmed and see if I can find a full text version. WLU (t) (c) Wikipedia's rules:^simple/_complex 10:40, 29 September 2010 (UTC)

[11], [12] (some sort of weird pubmed-indexed video? Here is apparently the pdf), [13] (need full text). WLU (t) (c) Wikipedia's rules:^simple/_complex 10:47, 29 September 2010 (UTC)

WLU - lets face it, nothing is going to convince you. One of the biggest health providers in the world are rejected as a mere insurance company. Germany, UK and Europe recommend acupuncture as part of the treatment for chronic lower back pain, this is rejected by you you know better. You request authoritaive information on acupuncture research I offer a peer reviewed database of 1900 odd articles, you offer publications who provide opinion in return. The American College of Physicians and the American Pain Society have issued joint clinical practice guidelines recommending that clinicians consider acupuncture as one possible treatment option for patients with chronic low back pain who do not have a response to self-care. Furthermore, the North American Spine Society recently concluded that acupuncture provides better short-term pain relief and functional improvement than no treatment and that the addition of acupuncture to other treatments. The fact that the treatment is past the study stage and is provided by mainstream health organisations is not important as far as you are concerned? Recent studies with fMRI on humans and animals can demonstrate that verum acupuncture effects the brain cortex differently to sham or placebo, and you want me to provide you with more information? You have quoted wp guidelines to me all the time. I will respond with wp:npov. Wilfridselsey (talk) 11:21, 29 September 2010 (UTC)

What would be required to un-convince you? If some of my questions about the brain imaging study could be answered, if they could be consistently replicated by various research groups, if they had different placebo conditions which addressed my criticisms about the current placebo condition and all converged on a common finding, then I would be convinced. It's the rare phenomenon that is established by a single study, particularly one that is ambiguous. The Milgram experiments were conducted over years, in various situations, with lots of consistent replications despite changing circumstances, with deliberate manipulation and testing of the independent variable that showed a dose-response effect. That's convincing. This is a single study, and though suggestive, it is not convincing. That is why we insist on a secondary source for these things, not a single study. You haven't responded to my, and Anthony's criticisms of the "1900 studies" nor the fact that this information is actually included in the article. You don't have to convince me, you have to provide reliable sources to substantiate your point - the problem is, there are more reliable sources that contradict your belief in the efficacy of acupuncture. It's not my fault much of the research on acupuncture is shoddy, and as the research and placebo gets better the efficacy drops off - but that is the reality of the situation and one that, per WP:NPOV, should be discussed. It is disingenuous to portray acupuncture research as a slam-dunk when there are a variety of sources that criticize the research base as biased, poorly-controlled, old and inconsistent. Is it really surprising that acupuncture is better than no treatment? No. Can that easily be explained by acupuncture being a dramatic placebo? YES.

Acupuncture is a contested topic in the medical literature, with lots of criticism that shouldn't be written off. The page lists numerous conditions for which acupuncture is supported, but also, appropriately, lists the reasons why the research isn't necessarily as simple to interpret as one might think. So in response to your citation of NPOV, I will respond right back with NPOV, as well as MEDRS which insists on review articles rather than primary sources. I've linked some, we need to look into the full texts and see what they say. There is a section on brain imaging which can be expanded, so the next step is to stop wasting time on primary research results and start looking into literature reviews - often promising, just as often inconclusive. WLU (t) (c) Wikipedia's rules:^simple/_complex 11:50, 29 September 2010 (UTC)

You have made my case for me. I don't need to respond. Wilfridselsey (talk) 12:04, 29 September 2010 (UTC)

Good, I'll consider the current page adequate then, and the discussion closed. WLU (t) (c) Wikipedia's rules:^simple/_complex 14:01, 29 September 2010 (UTC)

No you don't get away that easy. I am willing to accept Anthony's point that the Pomeranz citation is out of date. But as you recall my request was very narrow. I repeat, in the statement by the National Health service, we should say: " The National Health Service of the United Kingdom states that there is "reasonably good evidence that acupuncture is an effective treatment" for chronic lower back pain, nausea, vomiting, osteoarthritis etc.. as that was in their statement and they are now offering acupuncture for CLBP. I also suggested that we put something along these lines somewhere:

"There has been some evidence to suggest that acupuncture maybe effective in the treatment of chronic lower back pain when used with a regime of conventional therapy, including exercise and manipulation. Several major health organisations now recommend a combination of conventional treatment and acupuncture for chronic lower back pain."

You assume that I am an acupuncture advocate, I am not, however this is an important development as it's a recognition by major health organisations that acupuncture is effective in this SINGLE case Wikipedia should reflect that. I do not think that it requires comment as you have qualifications about the efficacy of acupuncture for chronic LBP in other places, but this was reported widely on the media, so is another reason to include it. As far as the 1900 odd articles are concerned. NHS Evidence is a medical search engine, all the articles come from a variety of sources and are peer reviewed, so you will find some of the papers that you cite listed. But not on vet. medicine.

I do not think that my request is unreasonable? Wilfridselsey (talk) 14:45, 29 September 2010 (UTC)

Not unreasonable, but I would say redundant. Have you actually read any of the sections I pointed to where your points are essentially already addressed?

For acute low back pain there is insufficient evidence to recommend for or against either acupuncture or dry needling, though for chronic low back pain acupuncture is more effective than sham treatment but no more effective than conventional and alternative treatments for short-term pain relief and improving function. However, when combined with other conventional therapies, the combination is slightly better than conventional therapy alone.^10,61 A review for the American Pain Society/American College of Physicians found fair evidence that acupuncture is effective for chronic low back pain.⁶² Conducting research on low back pain is unusually problematic since most patients have experienced "conventional care" - which is itself relatively ineffective - and have low expectations for it. As such, conventional care groups may not be an adequate scientific control and may even lead to nocebo effects that can further inflate of the apparent effectiveness of acupuncture.⁵⁷

The National Health Service of the United Kingdom states that there is "reasonably good evidence that acupuncture is an effective treatment" for nausea, vomiting, osteoarthritis of the knee and several types of pain but "because of disagreements over the way acupuncture trials should be carried out and over what their results mean, this evidence does not allow us to draw definite conclusions". The NHS states there is evidence against acupuncture being useful for rheumatoid arthritis, smoking cessation and weight loss, and inadequate evidence for most other conditions that acupuncture is used for.⁶⁰

The page is already quite long (see WP:LENGTH and WP:SS). Singling out the NHS' recommendation on LBP is unnecessary, particularly when it is dealt with at greater length above. Acupuncture has been found effective for many types of pain and nausea, I see no need to further single out lower back pain more than it already is, particularly when it is heavily qualified to indicate the difficulties faced in trying to treat it and design an adequate placebo. Redundant, unnecessary, adding length to the page for little reason I can see. Put another way, why is it so necessary to single out lower back pain versus dental pain, pain during endoscopy and headaches? And should we note that it's not effective for addictions, asthma, chronic pain, depression, insomnia, neck pain, sciatica, shoulder pain, stroke and tinnitus? Particularly when this is a single recommendation paper from a single national health authority and there are over a hundred countries in the world? Why not Health Canada, Australian health services, New Zealand, and those just being off the top of my head for English-speaking countries? Arguably the entire mention is redundant to the actual evidence base the article draws from. Since we're obviously going to disagree, we have a couple opitions - wait for more editors' input, asking for a WP:3O if we don't get any, or a formal WP:RFC. WLU (t) (c) Wikipedia's rules:^simple/_complex 15:35, 29 September 2010 (UTC)

@WLU -- sure there are lots of national health authorities. There are lots of journals too. We need not cite them all, but the ones that are about acupuncture are good candidates, eh? :-) --Middle 8 (talk) 10:12, 22 January 2011 (UTC)

I repeat in the case of LBP it stands out because it has been generally accepted, not just as a principle but also in practice. BTW- note 62 leads to a dead link probably because it is out of date. This article is from July 2010, [14] , which points to a paper in the New England Journal of Medicine. Note that the article gives current recommendations from the American College of Physicians, the American Pain Society and the North American Spine Society for incorporating acupuncture into a treatment plan.

I don't think that resolving our little dispute will fix the main article it's way too long and rambling. It could do with either blanking half of it, or splitting in two, one with how the practice of acupuncture works, and the other the arguments for and against.Wilfridselsey (talk) 16:04, 29 September 2010 (UTC)

Undent. Care would have to be taken for avoiding POV forking, particularly given the fact that both the underlying basis for acupuncture and its clinical efficacy are both heavily contested. There shouldn't be one article saying "This is acupuncture and how it works" (which assumes it works) followed by "this is the conditions acupuncture works on, but note that the reason why it works is heavily contested". Though I'm sure most people would agree that the current page needs a re-write and general clean-up, segregation would have to be done very, very carefully (if at all) to avoid one page discussing the "mechanisms" of acupuncture (which is both false since there is no actual agreed-upon mechanism, and deceptive since it assumes that acupuncture "works") and another discussing clinical evidence and uses. It's probably better to clean up the current page than split it, there's a lot of minor, tangled discussions about different aspects. WLU (t) (c) Wikipedia's rules:^simple/_complex 16:21, 29 September 2010 (UTC)

Wilfrid, regarding your comment to WLU above, "Recent studies with fMRI on humans and animals can demonstrate that verum acupuncture effects the brain cortex differently to sham or placebo..." Are you aware of an authoritative review of these studies? I've only seen the primary study you mentioned earlier in this thread. [15] Anthony (talk) 17:30, 29 September 2010 (UTC)

This was the one I was looking at [16] and a more recent study [17] and this on humans[18] (talk) 17:45, 29 September 2010 (UTC)

Thank you. Anthony (talk) 18:18, 29 September 2010 (UTC)

No probs. I would like to hear your views on them. Regards Wilfridselsey (talk) 18:24, 29 September 2010 (UTC)

Both of those are primary sources, one on rats. They are not the secondary sources required by WP:MEDRS. Anthony, I linked some review articles in an earlier post on this thread - [19]. Just below the image above. WLU (t) (c) Wikipedia's rules:^simple/_complex 19:35, 29 September 2010 (UTC)

I think I've given this one to you already, Investigating Acupuncture Using Brain Imaging Techniques:The Current State of Play is a general review but does cite one of the papers (talk) 20:33, 30 September 2010 (UTC)

Sorry, but I'm not convinced.

"Designing a good placebo for acupuncture is actually quite difficult - altering the points needled addresses only one aspect of what 'acupuncture' incorporates, and you also have to distinguish between 'acupuncture', 'dry needling' and 'Traditional Chinese medicine' - each is a separate test."

Fine, then each can be tested. The fact that there is more than one system is not an argument against a double blind experiment.

"You have to control for nonspecific affects - the acupuncturist's own beliefs, which can leak through body language, duration of treatment, care, etc."

Yes, but (in my suggested experiment) if the patients have already been evaluated by other acupuncturists to determine the "correct" action, then the acupuncturist in the test does not have to do an evaluation. If the treatment is dependent on the beliefs of the practitioner, then it is not science, it is supernatural. If a doctor determines that a patient needs the shock paddles to restart the patients heart and asks another doctor to do it, it is irrelevant whether the second doctor believes in the procedure. This is how real treatments work.

The acupuncturists "body language" would be irrelevant in my example experiment; he would believe it is the right treatment.

"Many systems of acupuncture claim a need for a lengthy diagnosis based on the TCM approach, and practitioners will claim it's not 'real' acupuncture if you don't spend an hour taking pulses, interviewing, looking at the tongue, etc."

Fine, different systems can be tested differently. But this is sounding more and more like the arguments other pseudo-sciences make - when an experiment doesn't go their way, they blame the experiment or those being tested, saying that they weren't the real deal. I hear astrology proponents say the same thing all the time - when an experiment goes against them they ague that the test wasn't testing "real" astrology, ignoring that many do and it still fails. A couple centuries ago, phrenology proponents made the same claims. And the fact that in 5000 years they have failed to develop a unified approach is NOT an argument in their favor.

"But as far as this page goes, talk pages are not meant to be forums for discussion. We base the page on a neutral summary of what reliable sources say."

My point is that I think that it is NOT neutral. To me it reads like acupuncture apologetics. I am not trying to argue acupuncture, but the slant of this article. This article would give me the impression that there is very little evidence against acupuncture's efficacy, contrary to what I have seen in the literature. Contrast this article with the CSICOP position paper: http://www.csicop.org/uploads/files/Acupuncture_Paper.pdf.

For something as controversial and that has failed so often in experiments to produce clear results better than control groups, this article is painfully shy of contradictory arguments - it reads like something written by an acupuncture enthusiast who has put in a few token arguments against. I do agree that the article show show both sides, but it is hard to build a "con" when the "pro" makes its claims unfalsifiable by saying that science is incapable of testing it (claim it shares with other pseudo-sciences.) Really, the "con" portions of this article could be summed up as, "Well, there is 'some' (lets pretend its not 'a lot') but it doesn't count because acupuncture can't be effectively tested by science." Would that argument be accepted for any medical procedure? Would it be acceptable in any other wikipedia article?

While I do agree that there is some data suggesting that acupuncture has some mild effects in some isolated situations, that in no way justifies the claims made by acupuncturists and in no way supports the bias of this article. unsigned comment added by Ksjazzguitar (talk • contribs) 00:39, 30 September 2010 (UTC)

This article is POV

I don't have the standing on this subject and I don't have the energy to get into an edit war so I will not be the one to change this. But this is in no way a neutral article - it is an advertisement for acupuncture masquerading as a wikipedia article. I hope that someone fixes it.—Preceding unsigned comment added by Ksjazzguitar (talk • contribs) 00:39, 30 September 2010 (UTC)

I agree, it reads like an advert for acupuncture. PPdd (talk) 05:41, 25 January 2011 (UTC)

Notice how little the surgery articles talk about double-blind, sham studies. --Middle 8 (talk) 10:12, 22 January 2011 (UTC)

There is a big difference between surgery and acupuncture as far as double blind and placebo. First, results of surgery are dramatic beyond any possible placebo. If they are not, the surgery should not be done. Second, surgery has indirect support when it is inferred from other empirically based knowledge. Acupuncture is entirely different, since there are no corresponding known anatomical structures corresponding to it to indirectly infer it from empirical information, unlike surgery, which is based on anatomy. (In fact, anatomy means "to cut up".) PPdd (talk) 01:14, 26 January 2011 (UTC)

Three points. One, surgery generally has a much more obvious outcome - death, increased cardiac output, the removal of a tumour, the reattachment of a limb, massive weight loss after stomach stapling versus a lower score on a subjective instrument to measure pain or nausea (again, two symptoms incredibly susceptible to the placebo effect). Two, surgery has been tested and found to be an exceedingly effective placebo, indicating that the placebo effect is not unitary and that perhaps yes, it is important in some cases to use placebos in surgeries designed to improve quality of life and other subjective outcomes. Three and most important - the failings of one discipline does not justify another. The fact that surgery could certainly improve its research methodology in many cases does not automatically validate the use of shoddy research methodology in acupuncture, and certainly doesn't demonstrate it is effective. If you wish to criticize the methodology of surgical research, then go to the appropriate talk page, which is not here. This page is to discuss acupuncture. WLU (t) (c) Wikipedia's rules:^simple/_complex 03:31, 25 January 2011 (UTC)

@WLU: Your comment about talk pages is solemnly noted. My point is simple: both science and Wikipedia should strive to avoid double standards. Statements made about lack of evidence should be consistently applied across the board, as should qualifying statements about the difficulty of designing studies for procedures. Of course it should be easier to control for the variables in acupuncture compared to surgery, but that doesn't mean that it's easy in absolute terms. A procedure is, obviously, qualitatively different from a compound. Acupuncture is closer to surgery than it is to drugs in terms of the challenge in controlling variables. --Middle 8 (talk) 00:59, 26 January 2011 (UTC)

Continuing this discussion is pointless because I have seen no references cited and therefore there is no justification for changing the page. WLU (t) (c) Wikipedia's rules:^simple/_complex 12:08, 26 January 2011 (UTC)

Surgery is often a product sold by surgeons to make money, just as MDs push drugs for pharmaceutical companies to get repeat patients. Acupuncture is, however, from an even lower level of hell. PPdd (talk) 05:45, 25 January 2011 (UTC)

@HkFnNGA: Yes, surgeons who oversell their "product" are in dire ethical territory. OTOH, acupuncture (done with clean needle technique and standard safety precautions) is orders of magnitude safer than drugs or surgery. Ethically, the unnecessary use of acupuncture is far less harmful than the unnecessary use of drugs or, FSM forbid, surgery. I'm not sure how you reckon hellishness. --Middle 8 (talk) 00:59, 26 January 2011 (UTC)

The goal of medicine is to establish procedures with a high degree of effectiveness and a low degree of risk - where the benefits of the procedure offset the risks. Acupuncture may be safer than some surgeries and drugs, but its benefit has not been established and it does carry risks - punctured lungs, fainting, bleeding, infection, even with clean needles. That is my objection, in addition to its impact on science and critical thinking in general. Positing a form of magic as an explanation for a phenomenon is corrosive to empirical investigation. If a procedure has no true benefit, it should not be undertaken. If it has benefits only as a placebo, then the risks taken should be zero (i.e. nonpenetrating needles). And finally, the treatment should not be used as a substitute for actual medical care for even minor problems. One of the worst effects of CAM procedures is the badmouthing and downplaying of actual, effective interventions by practitioners - antivaccination advocacy, drugs are always bad, cancer treatment is just cut, burn or poison. This applies to acupuncture, where again, the benefits are not established, the risks are present, and it is predicated and promoted by most practitioners as a form of magic. Ethically, acupuncture should not be promoted for actual use until it has been clearly established whether there is a placebo-independent effect. That is the standard we apply for drug trials - until they are proven effective, they are used for research purposes only. That would be ethical. WLU (t) (c) Wikipedia's rules:^simple/_complex 12:08, 26 January 2011 (UTC)

I find it amusing that on one hand the page is claimed to be NPOV for not being critical enough, and on the other it is too critical. If you're pissing off both sides, usually that means the page is going OK.

KS, I sympathize with your points, and agree with most - most studies don't properly distinguish between true versus nonspecific effects, and acupuncture has been proven useful only in the treatment of the highly psychogenic symptoms of pain and nausea. But neutrality is determined by sources, and there are so many sources that report acupuncture uncritically that we're limited in what we can say. If you are truly interested in this, you need to start reading the scientific literature - books and articles - and finding ones that substantiate your points. The CSICOP is a reasonable parity source for fringe points of view (on this page, the "theory" behind acupuncture would count) but we can't rewrite the article based solely on that one document. Particularly not a document that is not a peer reviewed article. It can be integrated throughout with attribution, but can not form the core of the whole page.

WP:UNDUE states that we depict the page and topic in a manner equivalent to that existing in reliable sources. Until the scientific community comes to a united stance on acupuncture, we must portray the roughly-comparable sides. Fortunately there are papers like this which point out some of the issues involved in conducting research and in particular how that research is interpreted to give undue emphasis on its apparent efficacy. But there's still a limit. We aren't Quackwatch, but we can use it as a source. WLU (t) (c) Wikipedia's rules:^simple/_complex 10:39, 30 September 2010 (UTC)

Don't include me as pissed off because I think that you or the main article are anti acupuncture. My concern is that you have not reflected the fact that mainstream medicine has accepted acupuncture for one type of problem. It is a significant milestone for acupuncture. In the future it maybe discarded as bunkum. It does not mean that trials of acupuncture have been good science in the past or that it works. We all know that acupuncture is controversial, but you need to keep up with the latest developments positive and negative. Wilfridselsey (talk) 19:50, 30 September 2010 (UTC)

WLU - I have to support u for a change . Check this out [20]. Wilfridselsey (talk) 21:50, 30 September 2010 (UTC)

You have to reflect and substantiate the mainstream opinion through reference to reliable, secondary sources. That is how we show the mainstream opinion. If you have a concern, cite a mainstream, current, secondary source. Just claiming the article is biased is meaningless - you have to demonstrate it by reference to the literature. And I will repeat myself yet again - it is well acknowledged that acupuncture has been tested against low back pain. This is in the article. It's not unproblematic research, which is also acknowledged. The criticisms of acupuncture are easy to find, make eminent sense and neatly tailor with a possible explanation of possible results. So there's the argument that it is effective, and the argument that its effectiveness draws exclusively from placebo effects rather than the very act of inserting needles has some non-placebo effect. The "latest developments" include both positive and negative results and discussions, with (still) better controlled studies showing little effect that's can't be accounted for by placebo. WLU (t) (c) Wikipedia's rules:^simple/_complex 23:01, 30 September 2010 (UTC)

I accept your argument on sources etc. I have provided you with reliable secondary sources, and I see that Anthony has cited them in the main article. That is not my point of contention. I know that the efficacy of chronic lower back pain is discussed in the main article. My request, was not really about whether acupuncture works or not. Perhaps I have not made myself clear enough, by getting side tracked on an area that does interest me (fMRI). What I am saying is that mainstream healthcare providers and professional organisations have accepted that acupuncture plus conventional treatment as best practice for the treatment of chronic LBP. This was reported widely in the media worldwide, but obviously not important enough for Wikipedia? Whether you are for acupuncture or against, it is an important story and groundbreaking. I have provided you with the up to date policy of a variety of organisations. There are citations to news organisations that reported it in this paper, Interpretive bias in acupuncture research? which coincidently is against acupuncture, I think that it is a better paper than the CSICOP one, and the authors are quite authoritave, but I do not believe that it is peer reviewed so we can not cite it. Wilfridselsey (talk) 10:14, 1 October 2010 (UTC)

Wilfrid, can you link to The American College of Physicians and the American Pain Society joint clinical practice guidelines? Anthony (talk) 20:01, 2 October 2010 (UTC)

Clinical Guidelines Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society. - Recommendation 7. There's also quite an interesting news article on NPR here [21] Wilfridselsey (talk) 21:45, 2 October 2010 (UTC)

Thanks for that. Anthony (talk) 12:18, 4 October 2010 (UTC)

(de-indent) As a rule, statements by expert bodies, including practice guidelines, are good MEDRS's and should be included. It doesn't take much space to include them. They help show the present-day sphere of usage and degree of acceptance. --Middle 8 (talk) 09:37, 22 January 2011 (UTC)

Suggestion to preserve current organization of article, but work on some of the subsection paragraph organization and content

Three short-paragraph introduction and summary, using ordinary English as much as possible, First very general summary, Second (article sections 1-4) theory, history, and practice, Third (article sections 5-7) science and reception.
Well organized hierarchical article sections and subsections, listed in the article contents box, with general opening paragraphs, so a specific purpose user can quickly go to the content they are looking for, with specificity increasing as the section or subsection develops.
Most of the article sections and subsections are well organized, and flow well from general and simple, to detailed and technical, but some of the article subsections need some more work.PPdd (talk) 21:43, 27 December 2010 (UTC)

That seems like a good plan to me. Do you want to put here what you have in mind for the lead section? The guideline covering the lead is WP:LEAD. The table of contents is automatically generated from the ==Section== and ===Subsection=== headings. As far as the structure of the body of the article is concerned, although this is an article about an elaborate placebo, it makes claims about health and efficacy, so should follow WP:MEDMOS; but your strategy looks good to me.

If you need a pay-per-view review article, I can access most journals indexed on PubMed and would be happy to email to you. If you can make the whole thing more concise, and use fewer references (by citing the same textbook or review for several claims, rather than a different reference for each claim), that would be fantastic... but that's a huge job. Good luck. --Anthonyhcole (talk) 12:04, 17 January 2011 (UTC)

Suggested lede paragraph structure

I suggest that the lede be organized as follows - First sentence definition, First pragraph:very general objective definition, Second paragraph: Description of beliefs, Third paragraph: Science and criticism; Fourth paragraph: Reception (e.g., affect on threatened and endangered species, world prevalence) PPdd (talk) 02:46, 27 Januar 2011 (UTC)

Can you propose some text? --Anthonyhcole (talk) 03:22, 27 January 2011 (UTC)

@PPdd: "effect on threatened and endangered species" -- You might be thinking of some TCM "herbal" compounds (which can also include animal parts), but there's nothing about that germaine to acu. Sounds like just another way to try to depict acu in a negative light. --Middle 8 (talk) 14:59, 27 January 2011 (UTC)

I am wondering if you are all aware that the first section has a lot of typos and run on sentences and ideas. It also does not present a succint intro of the field. TCM and acupuncture are not separate, acupuncture is included in TCM (Traditional Chinese Medicine). It does not incorporate it, it is the other way around, acupuncture is a branch of TCM. Also, more than half is criticism, which should typically be in the criticism section, or not in intro. Am I wrong about this? Please excuse any lack of wikiquette, some of my comments should be more questions, than comments. Soll22 (talk) 21:09, 7 February 2011 (UTC) Also, issues with the sentence "Acupuncture's effectiveness for other than psychological effects is denied by the science based medicine community." The sentence is innacurate. There is no consensus about the effectiveness of acupuncture in the "science based medicine community". Also, define science based medicine community. Psychological treatment is actually the most controversial facet of acupuncture in the "science based medicine community" that you mention, and it is far more commonly accepted for musculo-skeletal pain disorders. Mental health (psychological effects, as is stated in the second sentence, first paragraph) is generally considered outside the scope of practice of acupuncture in most states. Does this statement really belong as a intro to the Acupuncture entry?Soll22 (talk) 21:19, 7 February 2011 (UTC)

Tongue map of the body

At right is a motor cortex map of the body. TCM has a toungue map of the body. Does anyone know where a pic of such a map is? PPdd (talk) 04:05, 27 January 2011 (UTC)

Chances are one has not been uploaded to wikipedia or the Wikimedia Commons. The best way to acquire such an image is normally to make it yourself - take a picture of your tongue and map it using image manipulation software based on a reliable source. Alternatively, you can contact people who have one on a website and ask for permission to use it. Unfortunately this is subject to rather stringent conditions. My suggestion is to read up on our image use policy and go from there. Personally I hate trying to work with images I don't take myself. WLU (t) (c) Wikipedia's rules:^simple/_complex 11:49, 27 January 2011 (UTC)

Thanks, but I don't know where to find such a map. The tongue-body relation is so fundamental in figuring out where to stick needles in the body (e.g., based on chew marks on the tongue) that thre must be ancient or otherwise unprotected images all over the place. I just don't know where to find them. PPdd (talk) 14:54, 27 January 2011 (UTC)

If you are in a city with a TCM college in it, you can use their library to get an image. Tongue Diagnosis by Giovanni Maciocia is a basic book. Tongue diagnosis is complex, and is NOT based on "chew marks". There is specific language to discuss tongue topography and it relates to a complex of issues in the organ systems in Chinese Medicine. Soll22 (talk) 04:06, 7 February 2011 (UTC)soll22

We can't use other people's images at Wikipedia witout a written authorization. (I don't know the exact rules, see WP:Commons.) If you are in the field, perhaps you might be able to draw one, or get written permission, and we can use that. PPdd (talk) 04:25, 7 February 2011 (UTC)

Alright I will look into it. Just getting used to all the rules and regs of wikipedia. Soll22 (talk) 21:04, 7 February 2011 (UTC)

Lede reverted to earlier, sourced, better version

I noticed that the lede has drifted away from using sources (a stylistic preference that is conducive to POV-drift) and toward the inclusion of unsupported assertions and OR. I did a pretty massive revert, per WP:BOLD, to the lede, restoring one iteration of a pretty longstanding, stable version from 22 October 2010.

Most of us probably know that one needs a REALLY good source to say it is that way as opposed to saying that X source says it's that way. PPdd, try to find a source of unimpeachable stature saying that scientists and historians are now certain that the location of acupuncture points was determined only metaphysically and had nothing to do with empirical observation.

Additionally, the dichotomy between "alt-med" and "EBM" is not one that is generally used (e.g. Ernst doesn't, nor does Institute of Medicine); "alternative" can denote sphere of usage. See sources in first part of alternative medicine. I also removed another unsourced sentence asserting that TCM's points are based solely on metaphysics and the like. This isn't Skptical.Inquirer.Pedia. Again, we need sources, and really good ones, to speak in the encyclopedic voice and say that "X is the case" rather than "according to source Y, X is the case".

Whoever stripped the sources out of the lede did a disservice to the article; I'm just going to revert to an earlier version that had them, because otherwise some editors tend to tweak prose to fit their assumptions without strict adherence to sources. What is the advantage of a lede section that omits sources, diverges from the article and reads like a generic skeptical criticism? The version to which I reverted at least has sources and fairly depicts the various issues in the article, rather than drifting into more and more variations on "it's metaphysical, not EBM". BTW, the definition in this version implicitly takes into account Hk's note about non-TCM needling being called acu. --Middle 8 (talk) 14:59, 27 January 2011 (UTC)

Middle 8, I undid your revert of the multi-editor created NPOV lede to a pro-"acupunture is not nonsense" lede. The sources for the lede should be in the article body, which is summarized in the lede. Acupuncture is not a very complicated subject. It is a superstition based ancient practice, like blood letting, which survived by tradition and authority, but is now believed to be nonsense because it's occult foundations and their predictions about locations of points has been demonstrated to be inconsistent with anatomy and physiolgy. I had put in RS on these numerological bases, and inconsistencies with anatomy and physiology, but I guess they were deleted. Brangifer may also have put some RS on these in some talk page remark somewhere, but I don't remember where right now. PPdd (talk) 16:26, 27 January 2011 (UTC)

There is bound to be some overlap between tender points, trigger points, and acupuncture points, but coincidental overlap doesn't justify equating them. In some cases there are bound to be some points discovered through experience, which Middle8 correctly points out. While the first two will have some biomedical/histological basis, and if an acupuncture point corresponds to one of the first two, a biomedical explanation may exist. Acupuncture points have no consistently reproducible histological basis since they are a metaphysical construct from ancient times. As Felix Mann, founder and past-president of the Medical Acupuncture Society (1959–1980) and the first president of the British Medical Acupuncture Society put it: "...acupuncture points are no more real than the black spots that a drunkard sees in front of his eyes." There is some poor quality research produced by believers and published in poor quality journals (instant access for publicizing your own work online) which is used to make a connection, but again, coincidental overlap doesn't justify equating them. This is a typical pseudoscientific attempt to use the trappings of science to boost the reputation of unknown or dubious matters.

We even have a two-sentence section here ( Acupuncture#Myofascial trigger points correspond to acupuncture points ) which has a heading that very boldly proclaims they "correspond" in a manner that would lead readers to believe they are identical. It's very questionable to use primary research from believers in this way. That needs fixing. This error has been duplicated in other articles. -- Brangifer (talk) 00:39, 28 January 2011 (UTC)

I agree with Brangifer's comment about coincidental overlap and metaphysical basis. In fact, I am surprised that there have been aby studies at all given the metaphysical basis (which was completely removed from the Traditional Chinese Medicine article lede first paragraph, after which I put it back in, only to have it removed again by another editor). The coincidental overlap phonomenon is similar to "shopping statisticians", where if a researcher get no results from a statistician using one method of data analysis, the researcher keeps going around until they get a statistician whose emethods show some minute effect. As far as I read, the "overlap" is based on one particular definition of "near", which can be shopped from set of points and level of nearnesses to another set of this pair. PPdd (talk) 01:12, 28 January 2011 (UTC)

Can we find a better term than "correspond to"? Perhaps "substantially correlate to" would be less misleading. Or we could give the more detailled numbers. We must not, though, presume the paper is badly done, simply because we dislike its conclusions. LeadSongDog come howl! 01:41, 28 January 2011 (UTC)

We should use plain English when possible, and accurately state journal conclusions, as well as conclusions of other studies and analyses. Most studies hav found no correspondence, just the one sort of whacky fringe science tirgger points paper (the existence of trigger points is not widely accepted in medicine, only widely used in alternative medicines) which is based on the work of just one now dead other scientist trying to be the president's physician.

Metaphysical basis dispositive - The fact that the points are determined by the "number" of rivers (what counts as a river is arbitrary) in one Chinese Empire (what counts as an empire boundary is arbitrary) and the "number" of days in a year (which is not even 365, but only close to that) should be dispositive. Science shows that there is no correspondence between the human body and the numbers of rivers/earth spin cycles per revolution about the sun. And what this has to do with all of the snake oil/sea horse nonsense actually prescribed by acupunturists, and consumed all over is another whacked out belief (reasoning to tiger's penis for virility?). PPdd (talk) 01:56, 28 January 2011 (UTC)

I still see primary research being used. Eliminate the whole section (all three sentences). The latest one doesn't even mention acupuncture (at least the abstract). Note that needling without meridians isn't acupuncture. Neither is electroacupuncture. We're not supposed to engage in our own OR or promote OR found elsewhere, and primary research is essentially OR. -- Brangifer (talk) 04:09, 28 January 2011 (UTC)

I've removed several primary sources and all of the headings but one. Sections should not be two sentences long and headings should not make definitive statements like that. Also removed some unsourced sections which would be good if sourced but as is fall under WP:PROVEIT and without proper attribution and sourcing read too much like POV-pushing. And that's coming from someone who thinks acupuncture is a steaming pile of bullshit. WLU (t) (c) Wikipedia's rules:^simple/_complex 20:37, 1 February 2011 (UTC)

I agree with your NPOV edit, but acupuncture is BS? BS has a nonplacebo effect as a fertalizer for plants. Don't overrate acupuncture. PPdd (talk) 03:24, 2 February 2011 (UTC)

Though I appreciate your comment, I must point out that your analogy only works if we are discussing acupuncture for plants. As yet, I have never seen a medical application of bovine feces on human subjects. Though given alternative medicine's approach to...everything, it's pretty amazing they haven't tried colonic irrigation with actual bullshit. WLU (t) (c) Wikipedia's rules:^simple/_complex 12:10, 3 February 2011 (UTC)

Analogy-shmalogy, it turns out that flying feces is literally part of TCM[22]. WLU, once again you are essentially correctin your prognostics. Your forecasts indicate that you have your finger right on the pulse of TCM... and its tongue, in this case. I am part Native American (Apache), and I had some very strong maté, a traditional native south american medicine which was said to promote my “general health and well being”, and it tasted just like the fresh bovine product smells. PPdd (talk) 15:25, 10 February 2011 (UTC)

Nonsense, BS? Say who (or WHO)?

Hi Hk - re your reply to the thread-starter above (beginning with the phrase "Middle 8, I undid your revert of the multi-editor created..."), here are a couple of points to consider (also relevant to some of the discussion above, e.g. regarding the merits of fertilizer):

(1) A minor point: The version to which I had reverted was just as much a "multi-editor"-authored lede as the present one, so I have no idea why you bring that up as if it were some sort of advantage.

(2) A major point: If you believe that the version to which I reverted is (quote) ""pro-"acupunture is not nonsense"" (unquote), and that that's bad, then you do not understand the topic or NPOV. There is no scientific consensus that acupuncture is nonsense, bullshit, horseshit, or whichever pejorative you think is the most hilariously trenchant. None. In fact, it's not even a majority opinion. What I just said is easily falsifiable by the citation of a source (WP:BURDEN). Provide that source, please, or if you can't, please stop editing as if it were true. What we can say is that there exists *a* view along the lines that acupuncture is "nonsense", and a spectrum of opinion between that and something like the WHO report (cite in article here), or the NCCAM, or the AAMA, etc. There is no single majority view on acupuncture, let alone a consensus one. If I'm wrong, all it takes is an adequate source that is a sufficiently powerful RS to illustrate scientific majority and/or consensus view, along the lines of what we require for category:pseudoscience (summary of current consensus on WP, as I understand it, here: User:Middle_8/Pseudocat).

(3) Speaking of the WHO report, the text is better in the article (compared to the wordy version before), but the attribution still needs to be changed to the WHO, period, and not "Zhu-Fan Lee". 2/0 and Brangifer, it's good to have objective eyes here; you might have a look at this (a good summary, referencing this higher up on the page) in the archives, and see if you don't agree that the misattribution of the WHO report to one of its contributing authors wasn't classic wikisophistry (and perhaps, heaven forbid, a bad-faith attempt to reduce its weight). Ernst himself noted, in his criticism of the WHO report on homeopathy, that it indeed carries a great deal of weight; it should be treated accordingly, per WP:TRUTH. Ernst quoted[23]: “Any report WHO puts out will have an impact”, says Ernst, who says in debates supporters of acupuncture will counter his evidence by simply citing the claims backed in the WHO report. “Who am I against the WHO?”, he asks. “What better name could you think of but WHO?” Ernst is not speaking ironically or asking a rhetorical question. He is stating, correctly, that the WHO carries a great deal of weight, and that it's a damn shame that such a weight-y source wrote a report that he believes, with no small amount of justification, to be biased (as attributable views on controversial subjects frequently are). I imagine we can handle the weight issue more gracefully than by falsifying the source's attribution, don't you? We can have a robust, informative article about acupuncture that doesn't have, as a unifying and primary subtext, "acupuncture is nonsense". We also should, per NPOV, VER and OR. regards, Middle 8 (talk) 06:24, 2 February 2011 (UTC)

Of course, Ernst is making this statement in light of the lack of evidence for acupuncture and makes this statement to detract from the weight the WHO should carry in this case. For this suspect therapy the WHO is a political document as much as it is a scientific one, and it is one that has been criticized. Appropriate weight means writing the summary of the WHO document as well as any criticisms. I still don't have a problem with noting the author, and frankly don't think that most readers would notice if we changed the author to S. F. Adams. WLU (t) (c) Wikipedia's rules:^simple/_complex 12:10, 3 February 2011 (UTC)

We aren't too far apart on this. Yes, politics are involved. It remains the case that the critics are less weight-y than the WHO; they should be cited, but the WHO remains the stronger source (which is Ernst's exasperated point -- their is truth in both our takes on this). We do need to make sure the article reflects the lack of consensus rather than an imagined consensus that it's all nonsense, and that we give adequate weight to the view that acupuncture is valuable for certain conditions. That is a view compatible with EBM: lacking higher-quality evidence such as meta-analyses of RCT's, one looks at the evidence at lower rungs of the ladder. That was what Sackett said about it, anyway. --Middle 8 (talk) 16:11, 3 February 2011 (UTC)

Yin and yang in article's lede pic

WLU's newly installed lede pic is quite beautiful. The drawing "balances" the hollow empty space at left with a solid figure at right, just like in acupuncture theory, and even looks like a picture of yin and yang. Note that although the belly button is misplaced, the true center of gravity is over the subjects supporting left ankle (to the viewers right), just as in Michaelangelo's drawings. PPdd (talk) 18:21, 4 February 2011 (UTC)

I just think the last one sucked. WLU (t) (c) Wikipedia's rules:^simple/_complex 18:24, 4 February 2011 (UTC)

Sucked for a lede, but not for a picture in the practice section. I loved your "brothel" comment. I didn't notice it on first viewing. I once got a moxibustion treatment from a stripper friend. PPdd (talk) 18:38, 4 February 2011 (UTC)

Note that Michaelangelo's figure's buttox points left to the west, and the TCM drawing's figure's buttox points right to the east, with the Americas in the middle, in keeping with the "spirit" of yin/yang. So, let the qi flow freely in art. (That was a normative statement, so is neither true nor false.)PPdd (talk) 15:13, 8 February 2011 (UTC)

Please help find RS and restore pregancy termination content to article

Please help find RS for

"Risk of terminating pregnancy with the use of certain acupuncture points that have been shown to stimulate the production of adrenocorticotropic hormone (ACTH) and oxytocin, and with unsterilized needles and lack of infection control: transmission of infectious diseases. (such as hepatitis B, hepatitis C, HIV I remember seeing confirmed cases of hepatitis B ... needs a ref, though)"

, which I removed from the article as NRS. PPdd (talk) 22:11, 7 February 2011 (UTC)

Points for terminating pregnancy, i.e., specific points that do a specific thing? Perish the thought! Point specificity is moose poopie! Well, for "efficacy", anyway. For "risks", by all means, source it up at all costs! LOL --Middle 8 (talk) 22:35, 5 February 2011 (UTC)

Middle 8, don't undervalue moose poopie!! It can be used as fuel, or as an air freshener (depending on one's preferences), or as dinner (depending on one's biological kingdom)... not like that darned acupuncture, which can only, say, stop pregnancies (and only as a "risk" -- please, do not file under "efficacy" or my paradigm might start shifting, which would hurt worse than a wedgie since I have a pseudo-skeptical stick so far up my ass!) --Evil twin of Middle 8 (talk) 22:35, 5 February 2011 (UTC)

You meant bull moose poopie. I deleted it from the article, but put it here to give whatever editor put it in a chance to find RS, if any exist. It seemed specific enough to have come from some source. PPdd (talk) 22:11, 7 February 2011 (UTC)

POV article

the article is still POV but this time it is overly skeptical. three quarters of what is written should be moved to the criticism section. it is fine to be critical and skeptical of acupuncture but the article should be written in the same neutral format as other controversial subjects. — Preceding unsigned comment added by Metabradley (talk • contribs) 21:42, 5 February 2011 (UTC)

The reason for this is that much of the theory and practice content was NRS, and was moved to this talk page (above sections) to find RS. The science material was mostly RS, but that which was not was also moved out of the article to this page below. You can help out by finding RS for this content and moving it back to the article. PPdd (talk) 22:06, 5 February 2011 (UTC)

A couple points. First, per WP:STRUCTURE it is somewhat preferable to stitch POVs throughout the article and appropriate sections. It's not prohibited to have a "criticisms" section, but the ideal solution is to form a coherent narrative in which the criticisms are logically included in the appropriate section. Second, "neutral" does not mean "complimentary". There is a great deal of controversy regarding acupuncture in the scientific and medical community. Though practitioners think acupuncture "works", numerous researchers contest what good research on acupuncture is, and what is actually "working". That being said, we should fairly and accurately describe what acupuncture practitioners believe about acupuncture - and note in the appropriate sections where there is evidence to support these beliefs. We should justify this with reference to reliable sources - in the case of most things but efficacy, that means a scholarly book on the practice of acupuncture.

I do agree with Metabradley that the tone of the page is drifting towards in an overly critical direction. Personally I believe acupuncture is bunk, but that doesn't mean I think the page should be purged of an accurate description of what believers believe. I also agree with PPdd that the best way to address this is finding the best sources to depict these beliefs. As I said above, I'm not averse to using Cheng, I thought it was acceptable.

Also, as a top-level article it needs to address Japanese, Tibetan, Korean and Thai acupuncture as well. WLU (t) (c) Wikipedia's rules:^simple/_complex 22:29, 5 February 2011 (UTC)

All that being said - edits like this are strongly, strongly inappropriate POV ones. You don't address neutrality by removing reliable sources. WLU (t) (c) Wikipedia's rules:^simple/_complex 22:31, 5 February 2011 (UTC)

The PDF file in the right columb here[24] is a pro-POV and Japanese acupuncture perspective RS (it boasts Japanese is better than Chinese acupuncture because it is much less painfull). PPdd (talk) 22:36, 5 February 2011 (UTC)

the sources used are obviously not versed in chinese history or medicine and make broad, inaccurate claims. historically there are only two major rivers with any relevance in china (yellow river and yang river) not twelve. qi is not a "mystical" substance but a philosophical one, which arguable still has no place in medicine. the point locations are very much derived from human anatomy and take into account such things as muscle bodies, tendons and ligaments, bones, fossa (bone and soft tissue), foramen, nerve bundles and plexus. not using western terminology, of course. the name of many of the points reference the anatomical location. when the point system was brought to the west the points lost their anatomical names and were replaced with numbers. also, from the list of acupunture points wiki page (http://en.wikipedia.org/wiki/List_of_acupuncture_points): "Medical texts describe the location and indications of more than 400 acupuncture points." not the 365 astronomically derived points listed on this page. i am sure that there are wonderful articles that critique acupuncture; the ones used should not be listed among them. also when in the editing mode it is highlighted that the page is already too long so the burden should not be on people to add more material which balances out the POV but rather the POV should be removed in order to make the article neutral and shorter. plenty of pages have a criticism section, i read a lot of wikipedia articles and this is one of the few that includes the criticism in the introduction of the article. as well this article already has the criticism section so it would seem reasonable to put the criticism there. — Preceding unsigned comment added by Metabradley (talk • contribs) 19:27, 6 February 2011 (UTC)

I don't beleive in critcism sections, but rather sections by topic, with specific criticisms being enmeshed with claims and beliefs for each topic. For example, a reader might want only to read about pratices and criticisms point by point, and might be totally uninsterested in theory or criticisms of the theory. It is a matter of style.

The "balance" (yin yang) of the article will soon be restored, with RS for the theory material which was massively removed as NRS. But the material was not lost, just moved to this talk page in sections above, so RS can be found. Please help out finding RS.

PS, don't foget to sign (some people find "twiddling" to be a form of relaxation). PPdd (talk) 20:39, 6 February 2011 (UTC)

if you removed <365>, which was the exact number stated to be derived from astrological means, why didn't you remove the rest of the statement? i will look at the RS. mb. —Preceding unsigned comment added by 204.187.140.30 (talk) 21:46, 6 February 2011 (UTC)

yes, multiple pov are wonderful, however, the idea is to have INFORMED pov, not someone skimming the covers of an acupuncture manual or treatise placing a misinformed concept in the wiki entry and critiquing. The idea that the channels correspond to the rivers of China is a minor part of a huge treatise, and also mainly discussed as a conceptual metaphor.

It has no real significance in clinical practice. NO ONE refers to this in the clinical practice of acupuncture. This article seems to be written with a few exceptions by people only tangentially familiar with acupuncture in it's clinical form. — Preceding unsigned comment added by Soll22 (talk • contribs) 01:18, 7 February 2011 (UTC)

Soll22, you must have reliable sources to instert claims of efficiency. For example, you made this[25] edit, saying "It relieves pain, treats infertility, treats disease, prevents disease, promotes general health, or can be used for therapeutic purposes." You cannot simply state your belief that "it... prevents disease" like you did in that edit, unless you meet the standards at WP:MEDRS for such a claim. PPdd (talk) 01:34, 7 February 2011 (UTC)

Yes, I understand. I have to get through the rules & regs of wikipedia editing. However, there are a lot of misinformed and truncated statements that give a misleading view of acupuncture in this article. In my edit above, I was only experimenting. I simplified the sentence from "Practitioners claim it does etc etc." to "It does etc etc". I will be getting familiar with the rules, with real, acceptable edits to follow.. sorry about any current mix-ups. Soll22 (talk) 18:36, 7 February 2011 (UTC)

(Aside - Soll22, if you put colons before your comment, it indents the comment. So take the number of colons of the comment you are responding to and add one colon more; this will indent your comment one additional indent to the comment you are responding to, and other editors can tell it is a response to the last comment.)
Soll22, we clearly have different POV's ("POV" stands for "point of view"). But if you click here[26], you can see that I worked with editors with POV's that were the opposite of mine, and everyone ended up being very happy. I suggest you start a new section on this talk page listing things you think are innacurate or omitted from the article. I will then try to find MEDRS for them ("MEDRS" stands for the rules at WP:MEDRS), and help you get them in the article in a way that follows WP rules ("WP" stands for "Wikipedia"). MEDRS is tricky for both beginners and experienced editors, so just because you don't understand the rules, does not mean your ideas do not merit placement in the article, so if you put your suggestions on this talk page, I (or another editors) can help find WP:RS or WP:MEDRS for your suggestions, or help reword them so they can go in the article.
The first section of an article (before the table of contents) is called the "Lede" or "Lead". I suggest you do not try to change the lede in your first edits, because there are tricky rules for it, and it is strictly based on what has generally already been agreed to be in the article "body" (the part after the lede). It is best to add things with MEDRS to sections of the body, or delete things that do not have MEDRS. Please never delete things with MEDRS just because you do not agree with them.
Incidentally, there is a list of "edit summaries" on the "view history" tab of the article page. When you make an edit, it is best etiquette to put an edit summary, so editors can see why you made an edit. You can see what changes were made by comparing the diffrences of edits (called "diffs") by checking the little circles next to the two edits you are interested in comparing. PPdd (talk) 19:03, 7 February 2011 (UTC)

(This page is called a "talk page", or "talk", even though the tab says "discussion", so an edit summary that says "see talk" means "click the discussion tab and discuss in the relevant section".)
Abbreviations you will see in the "edit summary" on the history page include "rv" for "revert" or "undo", "sp" for spelling, and "gm" for grammer.

One last thing. New editors almost always get very frustrated and discouraged because they may do alot of work over a period of time, then suddenly someone comes along and deletes the whole bunch of work citing an obscure WP guideline. This is likely to happen to you, too, and happen again and again. Never take it personally, no matter how mad or frustrated you get. Your work is never lost, since it is on the history page ("view history" tab), and the information you gathered can always be accessed and fixed, if it belongs in the article.

Again, if an editor thinks this article is anti-POV, please find RS for material in sections with theory and practice content awaiting RS for insertion back in the article body. PPdd (talk) 19:18, 7 February 2011 (UTC)

There's not really such a thing as "anti-POV", which implies that there is somewhere a single "right" POV and also POVs that are "against" it. There are multiple POVs, we try to represent all the major ones using reliable sources.

Soll22 - you can't merely assert something is wrong. If a statement is in your opinion wrong, but unsourced, it can be removed. If it is sourced, you must figure out if it is reliable, particularly for medical claims. If it is reliable, you must figure out if it is accurately summarized. If a source is reliable, accurately summarized, current/a contemporary opinion - the only "option" is to find out if the point has been criticized or "countered" by another reliable source. Information is not removed because an editor thinks it is wrong. WLU (t) (c) Wikipedia's rules:^simple/_complex 18:42, 8 February 2011 (UTC)

PPdd I appreciate your taking the time to point out rules and regs. I will do my best to get a hang of things. My personal point of view, not to be confused with the POV of the entry is that as a member of a licensed profession, this article does not in any way represent the community or official (legislative) view of acupuncture. Therefore I am over eager to "straighten" things up, just as you guys seem to be. The pov is simply different. The reason why I jumped into the lede is because it seems to me the most not NPOV section of the wiki entry, plus it's the first one you see. There are statements such as the location of the acupuncture meridians which are based on the number of rivers, which doesn't even make logical sense. A location of several things cannot be based on a number of things. The majority of acupuncture literature includes no reference to the correspondance of meridians to the rivers in China. It is a philosophical metaphor that is not really part of the clinical literature. Yet the lede contains a marginal statement it's only statement about the channels. It is very POV.

Also, the lede contains a lot of criticism of acupuncture which there are several sides. I feel that while this is definitely one side, there are several other sides that should be represented, not in the lede. This should be a separate criticism section. As it reads now, the lede is THE criticism section, not a NPOV lede. Clearly the editors expressed their point of view in the talk page - acupuncture is pseudo-science, I hate acupuncture etc, obviously, not NPOV, and this is what comes through in the lede. There is no consensus in the medicine community, and this should be the NPOV of the CRITICISM section. I think the whole content of the lede, besides the typos and lack of logic of the statements, needs to be discussed. In the meantime, I disagree that it should be left as is. Soll22 (talk) 12:47, 9 February 2011 (UTC)

Model of POV cooperation in alternative medicine articles

The Anthroposophic medicine article was subject to edit wars and back and forth claims of POV from both sides. But it ended up with what appears to be unanimous consensus on both POV sides that they are all happy[27].
In a comment in one of repeated "comlaint-POV" sections above, an editor commented that since both POV sides were unhappy, this was a sign of a good balance.
I propose that the best sign of good balance is when both sides are happy, not unhappy.
Much of the disputes can be resolved by working on the to-do list at the top of this page, since most criticisms on both sides seem to involve a shift in definitions to make a point.
Further balance can be arrived at by working on finding RS for the massively deleted NRS theory and practice material, moved to the talk page above to find RS.
Let's balance our yin/yang the right way in a path to happiness, not unhappiness. PPdd (talk) 22:43, 6 February 2011 (UTC)

Seems like this ideal is turning out more like a "model of mono-operation". What happens when nobody else is playing along? Do you vote amongst yourself? Seriously, please don't stop -- this is the greatest thing that I've seen on WP in a long time. By "this" and "greatest", of course, I mean the tragicomic, obdurate refusal of others to *collaborate!*, not your own abundant and balanced labors. Carry on. Please. If you won't, who will? The future of the article is in your hands! You must allow nothing to deter you. I want this article to be a model that shows how amazing Wikipedia can be, and you are the best hope yet for shepherding it to a yet-undreamt-of state. DO. NOT. STOP. EVER. Sincerely, Middle 8 (talk) 11:29, 8 February 2011 (UTC)

I'm allowing my silence to represent support for most of PPdd's edits. Middle8, if you've got a problem with PPdd's edits, you need to object, and refer to reliable sources saying why they are problematic. This pointless baiting doesn't help anyone. WLU (t) (c) Wikipedia's rules:^simple/_complex 11:50, 8 February 2011 (UTC)

@WLU -- Say what? I love this guy's edits! They somehow epitomize Wikipedia - hence my encouragement. --Middle 8 (talk) 10:16, 10 February 2011 (UTC)

reply-> :) PPdd (talk) 22:01, 10 February 2011 (UTC)

Middle8, what I did in the anthroposophical medicine article was to be asked to come in as an outsider to a highly edit-warred article about a "spritually and supernaturlly based, homeopathy using, 'medical'" practice. I deleted almost the entire article's pro-anthrop-med-POV material as NRS, which was yelled and screamed at. I then found sources for the material and put it back in with RS, deleting the entire "criticism section", and distributing the criticisms topic by topic with the now RS pro-POV material. This was not a "mono operation" because I could not have done it witout the many greater "mono operations" put in to the article before I came in, and I only used WP policies in my edits of the many pre-existing "mono operations" of others. You also should know that I am a critic of all profit-driven-medicine and profit-driven-studies, alternative or not. Also, I was once giving a lecture at Stanford, lambasting the abuse of the word "energy" in alt meds, but then I called a coffee break as I had used up all of my "energy". Radical skepticism should be turned on itself, and be accompanied by radical open-mindedness. I actually believe (without MEDRS to put it in the article) that there is an "anatomic structure" corresponding to general needling, which is the body's system for reacting to mild pain or mild trauma, and that this system might have a greater effect on conscious psycholological states like pain and nausea than the consious effects of the mild pain and mild trauma. I also believe that traditional acupuncture might have, by trial and error, randomly happened across at least some locations that stimulate this body- wide structure more than just random needling. But I have no MEDRS on this belief to put it in the article.

I believe my main contribution to the acupuncture article is in the fourth lead paragraph, which sorts out enought ambiguitites in the article body to stop symantic debates on the talk pages, and limit debate only to MEDRS on objective facts about medical conclusions, and objective RS facts about beliefs and practices.

My other main contribution was to delete all of the NRS material I could find, from all POVs, and move it all to talk to find RS so it can go back in if it should. This is not a "mono operation", it is Wiki policy.

Middle8, please help find RS for content I deleted on theory and practice and this will help balance the yin and yang in the article. PPdd (talk) 14:59, 8 February 2011 (UTC)

"Anatomical structures"? Wikipedia:Writing for the opponent

Is a bodywide subcutenous stimulatable type of cells at non-acupuncture points that generates neurotransmitters an "anatomical structure"? PPdd (talk) 23:28, 6 February 2011 (UTC)
If so, is stimulation of it with needles "acupuncture", or is it a "placebo to test acupuncture against"? PPdd (talk) 23:30, 6 February 2011 (UTC)

removal of NRS POV and POV material - please help find RS

Two sentences were removed as NRS (and POV)

Many other countries do not license acupuncturists or require them to be trained. Most European countries with the exception of Spain, Portugal, Holland and Poland, require a medical license prior to acupuncture licensing, thus placing acupuncture under the domain of the medical profession.

Please help out by finding RS so these edits can go back in. PPdd (talk) 22:07, 7 February 2011 (UTC)

Um. You're using the terms "anti-POV" and "pro-POV" a lot, but I'm not sure I understand your definition, and if I do, whether I think its helpful. Famousdog (talk) 12:39, 8 February 2011 (UTC)

I just meant that each of the sentences looked like they were from opposites POVs, and I was hoping editors would help with both POVs at the same time to encourage cooperation. I just changed the wording since you point out that it might have the opposite effect of my intent. (I changed the size of your comment and mine so we don't distract from the section purpose of getting RS. Please change size back if you disagree. PPdd 13:49, 8 February 2011 (UTC)

I don't agree, and it throws off the threading. If you're simply removing unsourced material, all you really need to refer to is WP:PROVEIT; whether a summary is POV or not is a separate, and much more difficult issue. If a source is lacking or inadequate (i.e. it's someone's blog) then simply remove it and worry about whether the information is POV or not if and when it is replaced. WLU (t) (c) Wikipedia's rules:^simple/_complex 18:36, 8 February 2011 (UTC)

Unsourced information from lead

The following section was removed from the lead. WP:LEAD requires us to either provide sources for all information in the lead, or none depending on the page. Having a wall of text with no sources following several paragraphs full of sources is inappropriate. If this is a "draft" section, I would suggest composing that draft on a user subpage rather than on a main page. WLU (t) (c) Wikipedia's rules:^simple/_complex 12:04, 8 February 2011 (UTC)

There are various definitions of “acupuncture”, "effectiveness", and "need for further research", causing confusion about claims of acupunture proponents and confusing debates. First, in most cases “acupuncture” refers only to insertion of needles in traditionally determined acupuncture points. In this case, it is contrasted with randomly inserting needles, which is called a “sham treatment” or “placebo for acupuncture”, which is referred to as “needling”. Second, in some cases the very opposite is the case - “acupuncture” refers to this random needling, and this random needling is compared to pressing needles against the skin at the same points but not puncturing the skin, which is called "the placebo for acupuncture". So in the first case "needling with penetration" is called "the placebo for acupuncture", and in the second case "needling is with penetration" is the same as "acupuncture", but "nonpenetrating needles" is "the placebo for acupuncture". Third, sometimes, but less often, “acupuncture” refers to “acupressure”, which is applying pressure to traditional acupuncture points. Another reversal of definitions is that sometimes "stimulation" by pressing acupuncture points without penetration is called "acupuncture", not "placebo", and is compared to some other placebo treatment or "control". Another ambiguous usage is that some claim that acupuncture is "effective", and mean that it is effective for all of its claims, such as prevention of disease. Others might mean by a claim of "effectiveness" that it treats psychological states such as pain or nausea, but not necessarily other conditions. Some may mean by a claim of "effectiveness" for pain relief that the relief is dramatic or significantly large enough to justify study. Others may mean that it is only barely detectable but still measurable. Different definitions of “acupuncture” are combined with different definitions of "effectiveness" and this causes still more confusion about its claims. There is also ambiguous usage of "need for further research". Some may mean by this that spending money on additional research is a good expenditure of highly limited medical research funds, while others mean by it that, if conclusions are to be drawn, more research funds would have to be spent, even if they might not think doing so is a good place to spend limited research funds.

today's attempts and writing into the page with grievances

Please forgive my writing into the text with grievances. I found this page after, and was troubled by the loss of 1 hour's work. Anyway, the information in the lede is very problematic. I found my information to be both more accurate to acupuncture theory and better sourced (journal of pocket guide for instance). Though in that case I am willing to accept the poor quality of the source (NIH) but not willing to accept the quality of a pocket dictionary.

My discussion of point theory was far more accurate than the ridiculous river based statements, and my discussion of organs was intended to show the underlying anatomical basis for some of acupucnture theory. If you are going to say there is no evidence and then you are going to erase the evidence then we are looking not at a group of consensus finding and intelligent editors.

Here is my edit of the lede, please let me know what the problems with it are — Preceding unsigned comment added by Luke643 (talk • contribs) 18:26, 8 February 2011 (UTC)

"Acupuncture is an alternative medicine that treats patients by insertion and manipulation of needles in the body. In the 2004 NIH Consensus Paper on Acupuncture, it was determined that therapies that had undergone the most successful clinical trials were for postoperative and chemotherapy care, particularly for nausea and vomiting, postoperative dental care, low-back pain, headache, and tempero-mandibular disorder. Promising results in a handful of other therapies were discussed, with recommendation of further clinical trials..[1] Acupuncture typically incorporates traditional Chinese medicine (TCM) as an integral part of its practice and theory. The term “acupuncture” is sometimes used to refer to insertion of needles at points other than traditional ones, or to applying an electric current to needles in acupuncture points.[2][3]
Acupunture dates back to prehistoric times, with written records from the second century BCE.[4] Different variations of acupuncture are practiced and taught throughout the world.
The theory of pathology in Chinese medical practice(CM) differs from the modern trending of Western medical practice(WM). Rather than focusing on infectious agents (known in CM by various names, simply grouped under the term 'climatic factors'), disease pathology is believed to advance due to an imbalance of the correlative metaphor system based on early Chinese correlative Cosmology, including concepts such as yin and yang, the wu xing, (known as the Five Phases) and psycho-physical imbalance caused by "blockage" or "stagnation" of qi, a word variously translated as 'energy', 'breath', 'vital energy'[5]. These “systematic correspondences”[6] explain much of the phenomena of the persistence of health and illness in the human body. The system is not dissimilar to the Milieu intérieur theory of Claude Bernard.
Point location is based on sets of primary and secondary jingluo 經絡, or 'warp threads', 'winding channels', commonly called 'meridians' in the west. The channels each correspond and putatively interact with correlated internal Zangfu, often translated as 'Organs'. 10 of the 12 correlated organs correspond exactly with western anatomical organs, the Heart, Lungs, Kidneys, Pericardium (considered to have functionality equal to the major organs), Liver, Gall Bladder, Stomach, Large Intestine, Small Intestine, and Bladder. The final two, the 'spleen' and 'triple burner' refer to the spleen/pancreas and three vertical fibrous myo-fascial areas of the chest and abdomen (Upper, Middle and Lower), respectively.
The pioneering work of Dr. Helene Langevin, at the University of Vermont has given us clues as to how to explain Acupuncture points in bio-medical terms. She found that needles are 'grasped' differently at Acupuncture points then at non-acupuncture points. Based on her research, Langevin proposed a bio-medical mechanism based on "connective tissue planes" that explains the theoretical/metaphorical constructs of points, meridians, blockages, needle grasp, and sensation of 'qi', concepts that underpin the whole of acupuncture practice.[7]"

We can't see the sources in this version, please include the relevant ones as [http://www.example.com hyperlinks] (see WP:LINK for more info on the technical aspects). You may want to dig your version up from the history tab. Note that "pioneering" is a peacock term that should be avoided. Also, unless Dr. Langevin's work has been reported in a secondary source (in this case that would be a review article - not a primary study where she actually jabbed people with needles and measured stuff) then it is not appropriate for the page. There are lots of studies on the effectiveness of acupuncture - most are negative with pain and nausea being the exceptions. This should be noted, as should the fact that the results for these symptoms are themselves equivocal. The comparison to "western" medicine (terrible term - modern medicine placing its emphasis on empirical evidence rather than folk beliefs may have originated in Western Europe but it is applied with great effectiveness throughout the world) may be unwarranted. The sentence starting with "The systemic correspondences" is essentially unsourced, and waaaaaaayyyy oversteps appropriate. Too much detail on the theory as well, historically a notification of the points, qi and meridians was enough. And then we've got my previous comments about Dr. Langevin - really need to see the sources for this, a bare assertion is not enough. WLU (t) (c) Wikipedia's rules:^simple/_complex 18:53, 8 February 2011 (UTC)

I am happy to put this info lower down into the body of the text.

Luke, without checking the sources for RS, I put your edits in the article body, so you did not lose your work. MOS says to use plain English, not to use jargon, to avoid specifics (like a report of a single political body which reports by political "consensus", not by scientic peer review) in the lede; the lede generally summarizes in an objective manner, what is in the article body. A first comment on your edit (which I put unchanged without checking the sources) into the article body is that writing "based on early Chinese correlative Cosmology" instead of "a belief that heavenly bodies affect the body, known as Chinese astrology" is not plain English, and is known as weasel words for what is commonly called Chinese astrology in plain English, and is POV because of that. You must also state medical conclusions in the most objective manner, based on findings by secondary medical sources (see WP:MEDRS). PPdd (talk) 19:05, 8 February 2011 (UTC)

the comments below are relavent. I fail to see how "correlative cosmology" is not plain english when "chinese astrology" is. But whatever. the important thing is that the practice of acupuncture is NOT based on astrology in terms of sourcing for points and channels. I will approach this in my revisions to the page. Luke643 (talk) 05:16, 9 February 2011 (UTC)Luke643

Chinese Astrology is undefined - Correlative Cosmology is a specific term that involves multiple correlations between the trajectories of astronomical objects, natural phenomena, meteorological events, historical events, political events. It is a field that is part of chinese cultural studies, it is metaphorical in nature and involves concepts that are blended with what you might call "scientific". Astrology is typically the Western concept for the Western pseudo-science which has existed since antiquity for the first few hundred year, it was inseparable from Astronomy and Physics.

Soll22 (talk) 02:55, 9 February 2011 (UTC)

The Langevin article is apparently this one from 2002. This is a primary source, and thus essentially can not be used on the page. It is also nearly 9 years old, and apparently has not provided a scientific basis and revolution for the existence of acupuncture points or meridians. WLU (t) (c) Wikipedia's rules:

Explain "apparently has not provided a scientific basis and revolution for the existence of acupuncture points or meridians". Soll22 (talk) 02:55, 9 February 2011 (UTC)

Why is a primary source not acceptable?? I agree that the term "pioneering" was a bit strong. But it seems ridiculous to me that a peer reviewed article would be unnacceptable when a pocket medical dictionary is being used to determine what "practitioner's claim"

I see no reason why Langevin article should not be included. Age of the article is irrelevant. However, the basic premise that acupuncture points/meridians correspond with any anatomical structure is easily dismissed by the fact that the plethora of acupuncture systems means that pretty much any point on the body has some "significance". Secondly, there is "connective tissue" all over the body, increasing the likelyhood of a correlation. In addition, why on earth would sticking pins in connective tissue do anything? Famousdog (talk) 09:56, 9 February 2011 (UTC)

Famousdog - it is precisely that which occurred in her study. CT bound differently at acupuncture points then at non-points. But as I said, I am cool with not using it.Luke643 (talk) 17:05, 9 February 2011 (UTC)luke643

Note - Chinese astrology based acupuncture is not all from "on earth". PPdd (talk) 15:24, 9 February 2011 (UTC)

The Langevin article is a primary source Famousdog, that is why in my opinion it should not be included. It has also not led to a widespread acceptance of the idea that acupuncture points are related to connective tissue, making it a minority (of one) opinion (IMO). Soll22, primary sources are not acceptable based on WP:PSTS and WP:MEDRS. A primary source for a scientific statement is an original study - someone reporting on an experiment. Primary sources are not used because they are easily abused, can be cherry-picked to support specific conclusions, may be refuted by later experiments, may be freak or unusual occurrences, may involve small groups, improper blinding, poor statistics and other methodological failures that make it easier to discover spurious results, and generally are poor choices for medical or scientific points, particularly when it is merely a hypothesis that would substantiate a major and contentious issue like the existence of acupuncture points. Note that many studies, reported in secondary sources (that would be review articles) have found that sham needling of non-acupuncture points is just as effective as needling traditional acupuncture points, which suggests that Langevin's results are spurious. Put another way, primary sources are not acceptable because it is a policy on wikipedia. The reason itself matters less than the fact that community consensus has determined that primary sources are inappropriate. WLU (t) (c) Wikipedia's rules:^simple/_complex 12:18, 9 February 2011 (UTC)

Ok, I am reposting what I worked on yesterday. Again, the Lede should not include criticism of acupuncture theory, methods, or beliefs, as that information all must come in lower sections. The lede should state concisely what the practice is only. does this make sense to everybody?Luke643 (talk) 17:05, 9 February 2011 (UTC)Luke643

Please see WP:LEAD. The lead section very much should include criticisms because a) acupuncture makes medical claims, and b) the criticisms are very much part of the contemporary dialogue regarding acupuncture. The lead section should summarize the entire article, and that includes criticisms. Please review WP:LEAD. WLU (t) (c) Wikipedia's rules:^simple/_complex 17:19, 9 February 2011 (UTC)

thanks for that, I have fixed the lede to include the summary of criticism.Luke643 (talk) 17:29, 9 February 2011 (UTC)luke643

Additionally, I should clarify why the rivers/astrology statements are false. First, the lingshu (the Warring States text that the Matuk quotes) does not suggest that the points and channels come from rivers or the days of the year, and certainly do not suggest that they come from astrological incantations or rituals. Peter Deadman's analysis of the mawangdui text on acupuncture and physiology suggests that the formation of points was quite the opposite: unsystematic and based on points of tenderness in massage and exercise. Parralellisms are very common in classical chinese texts, and this one is no different. That there are 12 channels that correspond to 12 rivers in China (they certainly knew there were more than 12!) and points to the days of the year was a rhetorical device used to verify the 'natural' and cosmological significance of the points. But there is simply no suggestion in the literature that the pionts and channels originate in the rivers and stars. If my Columbia MA in Pre-modern Chinese History is not enough to convince the wiki world of the veracity of my reading of the lingshu, then I throw my hands in the air. Luke643 (talk) 17:23, 9 February 2011 (UTC)Luke643

While we value expertise in a subject here, we value compliance with policies even more. As a newbie here you need to be very cautious and not restore content that has been deleted. That's called edit warring and can get you blocked before you've even learned how things are done here. That would be shame. Solo editing is dangerous. We do things by consensus here. Take your new content and place it on this talk page first. We can then discuss it, tweak and revise it, and then, MAYBE, it might be acceptable as new content.

As I've written below, editing the lead is a rather dangerous thing, especially for a newbie. First make your concerns known here. Discuss them with other editors. Then, if a consensus emerges, changes can be made. Don't restore your deleted content without reaching such a consensus. There are reasons, in this case many, for why your additions are deleted. (They aren't really gone. They can be recovered and worked on, so your time hasn't really been wasted.) We have all been through this process of getting our first attempts rebuffed, often many times. Don't take it personally. It's part of the learning experience, and if you learn from it rather than getting upset, you'll show a positive learning curve and that will create a good reputation for you. That will be your capital here. It will help you when you really need help.

Also, as explained on your own talk page, please start to indent your comments, and always sign with four tildes, no more and no less. -- Brangifer (talk) 18:33, 9 February 2011 (UTC)

Luke643, when I started editing, I got very frustrated by all the rules, deletions, etc. This went on for months. After making about 4,000 edits, I still get frustrated, and am still learning and I still edit like a newbie. Other eidtors, including on this page, took their time and helped me out alot on this. If you have any questions, I will gladly return these favors to you, so just post a note (or frustration) on my talk page, and I will try to help, or refer you to someone if I can't. PPdd (talk) 18:46, 9 February 2011 (UTC)

indeed, thanks brang. as I said, I will be only working from this page now.Luke643 (talk) 21:23, 9 February 2011 (UTC)

Corrections

deleted following sentence: "Acupuncture's effectiveness for other than psychological effects is denied by the science based medicine community.Ernst_2006-02" The citation does not in any way prove that the science based community as a whole makes such a statement. Citation is also about a discussion which selects certain studies and not others, and draws certain conclusions. Mr. E. Ernst opinions can by no means be considered the unanimous opinion of the entire science based medicine community. "Science based medicine community" must be defined. It is a vague general term without a specific meaning. Numbers, members? If one person in the science based medicine community dissagrees, your statement is false. If you qualify your statement by "some" in the science based community, you are introducing a topic that belongs in the controversy or criticism section and misplacing it in the intro section. — Preceding unsigned comment added by Soll22 (talk • contribs) 02:08, 9 February 2011 (UTC) oh i forgot to signSoll22 (talk) 02:15, 9 February 2011 (UTC)

There are plenty of citations to that effect, so I am putting it back. Please tag unreferenced statements with {{Citation needed|date=February 2011}} before removing them, to give other editors a chance to provide refs. Now I have to trawl through the edit history to find out where the f*** that sentence was removed from. Famousdog (talk) 10:07, 9 February 2011 (UTC)

I do apologize for not using the correct tags. However, the point is that the statement was made as a general accepted statement from the point of view of an entity, the science based medicine community, that simply does not function as an entity. The science based medicine community has many members, each one of them with their own opinions.

The fact that Mr. Ernst suggests something in an article is by no means a license to draw conclusions that are stated as facts about the entire science based medicine community. Ernst himself made no such statement. The citation was misleading. The only acceptable conclusion from that article was the following: E. Ernst suggests that evidence effectiveness for the effectiveness of acupuncture in treating pain based issues is lacking, or debatable, based on the studies used in the article. And this sentence would belong in a section about E. Ernst, not acupuncture. Certainly his work is debatable, not saying without merits, but certainly up for discussion. If you wish to do so, kindly start an E. Ernst entry and enjoy yourselves over there.

I also deleted the sentence again 5 minutes ago, since it was inserted as a free standing sentence right after the first paragraph, which also has to do with the structure.

One of my criticisms about the sentence was that is was placed in the middle of a descriptive paragraph, not in the criticism section, where it obviously should be.

The sentence was also modified with frequently, as in frequently denied. That qualifier places the statement in the debate category. Some people deny, some people accept it, it is still up for grabs. Thus it should not be a blanket statement about how acupuncture is seen. The intro section is more than half criticism which is not acknowledged by the writers here.

This is definitely not NPOV. Just the fact that an opinion had been mentioned without being credited as an opinion but passed along as fact is a violation of NPOV. Soll22 (talk) 12:27, 9 February 2011 (UTC)

Please space your posts per the talk page guidelines as it makes it easier to read.

Edzard Ernst is seen as one of the primary critics of CAM and proponents of rigorous, science-based evaluation of the practices. His opinion carries weight, but if a sentence is justified solely through reference to one of his articles, it may be worth noting it as his opinion. That may be a strong statement to make, but it should not be removed - the article itself should be reviewed to ensure it is accurately summarized in the page. Sentences should also not be removed merely because they are dangling and not part of a paragraph - move it, integrate it, but don't remove it. I replaced it, and note that it was sourced to three citations, not merely one. Please do not remove it unless you can demonstrate that it is actively misrepresenting the sources it cites. Unless Ernst is publishing something in a non-peer reviewed venue like a blog, we do not necessarily need to single it out as his opinion - by publishing in a reliable source or scientific publisher, it carries the weight of the publisher itself. You have to demonstrate the publisher failed their due diligence, not Dr. Ernst. WLU (t) (c) Wikipedia's rules:^simple/_complex 12:46, 9 February 2011 (UTC)

Pill pushin' POV

The way the article is worded, it makes acupuncture sound like it significantly relieves nausea. As an uninsured purchaser of antiemetics in the hospital, I recall thinking that the antiemetics sold by pill-pushing pharmaceutical companies were about as useful as buying Rogaine to grow hair. A more objective and NPOV article edit on this would be, "Systematic reviews have found acupuncture to be as useless for treating nausea as antiemetics sold by pill pushing pharmaceutical companies." The existing POV article wording on this makes me sick to my stomach. (This is actually a serious request for a suggestion for rewording.) PPdd (talk) 15:08, 9 February 2011 (UTC)

well it seems like that kind of NPOV edit deals with a comparison of the two, not with one. There are fields of comparative science discussions which are defined as such. Discussing one particular field is not the same as a comparative discussion. The comparison elements must be agreed upon by everyone - acupuncture/pharmaceuticals, acupuncture interventions/surgery, etc. I also suggest, in the name of establishing a clear discussion, get an acupuncture treatment for the same complaint that you were attempting to treat with pharmaceuticals. I would assume that if you call up an acupuncturist and explain you are doing a personal experiment to establish the efficacy of an anti-emetic vs acupuncture treatment, they might give you a discount or even a free treatment. Otherwise most acupuncture schools offer discounted treatments in the school clinic, in most cities, under $30 a treatment, especially for financially disadvantaged, senior citizens or students. At the very least, most patients report a feeling of calm and relaxation by just being in an acupuncture office compared to an emergency room. I really do think that a personal experiment is in order, so YOU can have a clear idea. Since you know the inefficiency of some pharmaceuticals from personal experience, you can freely discuss it from that perspective. Your discussion of acupuncture does not have the same credibility because you freely mix sources and pov.Soll22 (talk) 15:41, 9 February 2011 (UTC)

I did go to an acupuncturist for pain, because a friend would not shut up until I did. I had pain due to a masively ruptured L5/S1 disc from my falling down a 100 verticle foot landslide, for which I received two neural surgeries for pain relief, after which I still had pain. You are right, the relaxed music and atmosphere was much better than an emergency hospital, as well as the time spent with me. But the honest acupuncturist told me that acupuncture's effects were, at best, very small, and would not help my severe pain, and referred me to a medical pain clinic for pharmaceutical treatment, without giving me acupuncture. PPdd (talk) 16:44, 9 February 2011 (UTC)

This discussion should be settled by sources. What are the best sources that exist for acupuncture relieving nausea? Have they been criticized? Pulling in personal experience as patient or acupuncturist is invalid. PPdd, I am getting increasingly concerned that the page is taking a perspective that acupuncture is completely ineffective. The first section raises great concerns that personal opinions and definitions are being applied to the article. There are certainly valid points that should be raised in the appropriate section - that virtually any point on the body could be an acupuncture point depending on the system should be noted, but I would place it in the TCM section. Issues with placebo treatments and sham acupuncture should go in research in my opinion. The first section of the page is a self-reference when it says "This article's meaning..." The inclusion of the phrase "or lack thereof" is problematic. The sentence "There are various definitions of “acupuncture”, "placebo treatment", "effectiveness", and "need for further research", causing confusion about claims of acupuncture proponents and confusing interpretation of scientific reviews." is unsourced and asserts an opinion. The page is being pushed closer to an entry of The Skeptic's Dictionary and this concerns me. Our first job is to have a neutral, accurate description of what acupuncture is generally believed to be, then move into issues of efficacy, placebos, theory, etc. The continuous shaving of meanings, even if sourced, can still be inappropriate if it pushes the idea that acupuncture is known to be nonsense. I am quite certain it is nonsense, but the scientific community at large is not and there is still large amounts of sincere (but in my mind credulous) research being done on the subject. Journal articles still talk about qi, acupuncture points, meridians and the like. We should as well - and note the dissenting opinions in the appropriate section rather than with the "voice" of the article.

Note that we do have a style guideline for medical articles, WP:MEDMOS. I believe the most applicable section would be drugs because there is no "treatment" section. Anyway, since this is a borderline article it's not settled. My personal preference was to put the history section first. This isn't a certain thing, I'm mostly noting it for reference if useful. WLU (t) (c) Wikipedia's rules:^simple/_complex 17:17, 9 February 2011 (UTC)

(I think )I corrected defects in the definitions section, removing NRS stuff and my own oipions I had not noticed I was inserting.

Re- "completely ineffective", see my section below "Proposed NPOV theme to keep in mind when editing this article". I have not yet read a skeptic article on acupuncture. I started reading a couple, but found that they argued using various ambiguities in the terms from the outset, so I decided not to bother reading any further. Before reading this article and sources cited in it, my "knowledge" about acupuncture came from MD's re consulting about data analysis at Stanf, and from an extensive talk with the smart and honest acupuncturist/osteopath that my friend insisted I go to.

Re - comparisons to antiemetics, I have some knowledge about this from numerous and extended discussions with high end GI and pain doctors, both post-op after surgery, and re nausea as a side effect of pain and of pain meds. The upshot is that state of the art medicine has little understanding of nausea, but many drugs have been proposed, mostly in the context of dealing with side effects of AIDS meds. I have not yet read the systematic reviews of acupuncture studies on this, but I wonder at the outset if in some of the reviewed studies, how there could not be a confounding of side effets of pain meds and nausea meds. To do a proper study withou such confounding, a post-op antiemetic would have to be given to a patient deprived of pain meds, which would be unethical. Similarly, acupuncture might have been given for pain control and nausea control at the same time, so there was no nausea from pain meds, and then this was compared with pain and nausea meds given at the same time. I cannot think of an ethical study being done in another way, but I may be wrong. PPdd (talk) 19:19, 9 February 2011 (UTC)

Your changes move too quickly for me to track given the limited amount of time I can spend on this, but I'll try to give the page a thorough read-through when I find the time. I will point out the fact that much of your comment is about your experience with acupuncture, pain and nausea when it should be what your sources say. Have you read Trick or Treatment? I see that as a good, evidence-based perspective on acupuncture and one that certainly informs my understanding of the topic. It points out the criticisms but honestly summarizes the results of research that gives acupuncture credit where it is due (even while pointing out that the evidence base still needs improvement). Reliable sources criticizing the evidence base are valuable, our own criticisms are not. I really, really suggest that you spend some time reading even the abstracts of the papers you are citing as the summary must follow from the source, not our opinion. Good review articles should discuss and evaluate primary sourcse on the basis of their methodology including controls - but those opinions must again come from sources. Note for instance, how I try to deal with this information - it's a passive-voice (less than ideal!) note regarding the evidence base for acupuncture, that says it has been questioned and improvements are needed. It doesn't say there is no evidence or that research is flawed, or go through a very finely-sliced analysis. We don't get to be adamant about things until the scientific consensus is clear and the only believers are true believers (like astrology or flat earthers).

I realize I'm repeating myself, but these points bear repeating as they lead to a better page with a more solid consensus supporting it. WLU (t) (c) Wikipedia's rules:^simple/_complex 20:27, 9 February 2011 (UTC)

I only put my experience here responding to Soll22" suggestion that I go to an acupuncturist. None of my edits are other than RS (except regarding confusion and ambiguity, which I deleted). Thanks for recommendation to Trick or Treatment, which I can not access yet. When that book uses the expression "acupuncture", does it refer to penetrating needles at TCM points, any penetrating needles, nonpenetrating stimulation of TCM points? Does credit due when it is due refer to credit for some kind of stimulation of one TCM point but not necesarily others, a credit of passing a .05 p-value in systematic review, no matter how tiny the .05 effect, or lasting releif compared to short-lived relief although not long eneough to matter much for outpatient treatment? Since I have heard good things about this book, I assume it clarifies all of these ambiguities. Similarly, I assume you mean by improvements are needed" that they are needed to make conclusions, not that you are suggesting a pressing need to spend money on improvements. Since I learned about MEDRS from you, I would like to get your take on my highly qualified wording designed to pass MEDRS in the "does it hurt" section. There are no secondary sources, but I worded it to pass MEDRS anyway, as the comments on painfulness are not primary studies, as the studies were not on painfulness, but were incidental to what the article is about. Peer medical and acupuncturist reviewers appear to let these comments be in the articles as if it is undisputed common knowledge, so did not edit the incidental comments out. PPdd (talk) 21:04, 9 February 2011 (UTC)

PPdd, I do appreciate you sharing your experience on the talk page, it gives me a better idea of where you are coming from. I myself am an L.Ac., and have treated several people with severe back pain who had already been in consultation with surgeons for vertebral fusion or other procedures. My patients got better, some slowly, some quickly, and after several months of weekly or biweekly treatments now only come for maintenance treatments once a month or less, and have regained 80% mobility. They have not been under any other kind of care with the exception of occasional ibuprofen & such. Acupuncture is notoriously difficult to calibrate as far as efficacy, since the points work in combination with each other and different points are therapeutic for different individuals with the same condition. I do respect the acupuncturist who referred you to a medical doctor. There are some conditions which are extremely severe that can greatly benefit from allopathic medicine. However this is a general statement.

I do know acupuncturists who would gladly take you on with your ruptured disc, and I believe that without a doubt you would at the very least have 50% improvement in the pain, if not some actual modification and healing of internal structures. To give you an example of how tricky it is to "prove" principles of chinese medicine and acupuncture, western medicine for example has always advocated ice for controlling inflammation. Acupuncture and Chinese Medicine always firmly sustained that ice slows down healing. Finally, a study was completed by Zhou Lan at the Cleveland Institute Neuroinflammation Research that showed modifications in the biochemistry of inflammation which supports the Oriental Medicine approach to trauma. Developed inflammation which develops uncontrolled by ice or cold applications actually stimulates a particular subset of growth hormone IGF-1 which improves healing speed and quality of tissue growth. This directly supports indications in Chinese Medicine of treating injuries, even in acute stages with warm applications, and contraindicates the usage of ice. [28] I can get a copy of the faseb jouranal if you like I cannot link to it here.

The fact that the priniciples of chinese medicine are not easy to research in clinical studies based on the existing paradigms does not mean that they are unproveable or false. Chinese medicine has only, in the past 10 years begun to establish research methodology that aligns it with the "hard science" areas of western research. Remember that efficacy is not the exclusive domain of hard science. Many western medical areas such as psychiatry and psychiatric medications are still a crap-shoot for most physicians. Many psychiatric meds work after random empirical observation of efficacy, where the patients improve under medication without any clear understanding of the pharmacological mechanism. Since clinical trials in certain situations are blocked by ethical considerations as you stated above, even certain branches of western medicine proceed without the rigour that you seem to imply it always does. Chinese Medicine has the advantage of being less risky than an unproved or under-proved western modalities, either pharmaceutical or surgical. While Chinese Medicine may not cure you, in most cases it will not harm you, which is more than you can say for allopathic treatments gone wrong.Soll22 (talk) 22:37, 9 February 2011 (UTC)

Why can't the principles of TCM be researched like anything else in "allopathic" medicine? If an intervention is effective, that effect should survive blinding, randomization, large numbers of patients, statistical analysis and placebo controls. If it's not, we should see drops in "effectiveness" with every application of a test designed to remove a particular bias. Research is indifferent to paradigm, if something works, it works, and it should work irrespective of who is doing it and where it is being done. To think otherwise seems like special pleading. How do you know patients aren't simply getting better due to the passage of time and natural healing? Why do you attribute that healing to acupuncture? This is specifically problematic for back pain, which has essentially no evidence-based treatment beyond "avoid bed rest". Comparing acupuncture to "regular care" isn't setting the bar very high since "regular care" isn't particularly effective. That's like carrying a rabbit's foot because it's just as effective as reading your horoscope. You are correct in noting that something can work without us understanding the mechanism - but that's a reason to research the mechanism. But first we should check to make sure it actually works rather than assuming it does. You don't have to know how an SSRI works in order to demonstrate that it helps with major depression. Again, research and empirical evidence properly gathered are indifferent to the beliefs of the researcher.

Was the ice research based on TCM principles? Are all TCM principles equally supported? Why does conventional research "work" for that finding, but not for others - like acupuncture? Again, this looks like special pleading - research is great as long as it confirms something we already believed - otherwise let's ignore it. Has this work been replicated in humans, who aren't mice (the subjects of this particular study)? And since TCM is primarily a 'physical' treatment - aimed at disease and disability rather than mental illness, isn't your invocation of psychiatry an inappropriate comparison? Why is TCM less risky? Particularly given things like contamination [29], [30], adulteration, [31], as well as delays in treating serious conditions. TCM may, or may not cure you, but if something carries risks but doesn't work, why use it? If it carries risks but it is uncertain whether it works, why prescribe it before confirming it works? If something carries no risks, why believe that it works - all effectively demonstrated interventions have predictable dose-response curves that at the extreme top-right end in toxicity. An intervention that has no adverse effects at any dose suggest it has no effect period.

PPdd, TorT does indeed address many of these points. I got my copy from the library. It's time well spent. WLU (t) (c) Wikipedia's rules:^simple/_complex 03:20, 10 February 2011 (UTC)

Libraries are second only to deserts and botanical gardens as my favorite places. Used book stores smell pretty good, too. PPdd (talk) 03:42, 10 February 2011 (UTC)

Famousdog's plethora

Famousedog wrote, "the plethora of acupuncture systems means that pretty much any point on the body has some 'significance'." Famousdog's "point" ("ambiguous points?") is a good one, and if anyone has RS on this, it certainly belongs in the article, since it will bring MOS consistency to the various sources cited, and make the article readable. PPdd (talk) 14:40, 10 February 2011 (UTC)

EBM section

Just wanted to say that although I may not agree with all the content in the EBM section, I do think that it's much better written than the lede or the recently proposed lede. IMO any subject can be discussed if it's well written, and I do see a real effort in the EBM section, at any rate more than I can put into it these next few days.Soll22 (talk) 21:12, 9 February 2011 (UTC)

Per WP:MOS, the lede sums up what is in the article body using plain English, and does not have jargon or too much specificity (like lisitng individual entities). If you make significant RS edits in the article body, they will likely be summed up in a general way and put in the lede. Beginning to edit can be frustrating, because of all the guidelines and policies causing deletions, so if your edits get deleted, WP:Be bold and keep making them, but always WP:assume good faith and have WP:Civility. (If you click on the links I just provided, there are guidlines and policies. Your work is never lost, and can be easily recovered by clicking the article's history tab, looking for your name and edit summary (which lets others know the reason for an edit, and also lets you find it easily), and clicking on the dated link to the left of your name. Then click edit, and you can recover your exact edit there. PPdd (talk) 23:38, 9 February 2011 (UTC)

That's great, but some editors (mentioning no names) are editing and undoing other editors' edits at such a pace that finding ANYTHING in the edit history is becoming extremely difficult. Can we all just cool it? Famousdog (talk) 14:03, 10 February 2011 (UTC)

In response to your and other editors comments, I, for one, am hereby slowing down on editing the article. I think Soll22, Middle8, and Luke643 have already done so. PPdd (talk) 18:01, 10 February 2011 (UTC)

2 dimensional points, and 3 dimensional surfaces; How deep does it go?

Another shifting definition is confusing me. A point has no dimensions. My edits have been almost solely based on RS already in the article. But something I cannot figure out from the content or cited RS that I have read, is how broad an area does the word "point" encompass, according to TCM or medi-acupuncturists, and how deep does the "point" go down into the body. There are a few acupuncturist editors here. Can anyone explain this, and maybe put it in the theory section with RS? PPdd (talk) 02:26, 10 February 2011 (UTC)

The points have varying depths, and different styles use different depths. The japanese often needle very superficially (<.3"), but the chinese will often needle far more deeply (up to 3") but it depends upon the point, the desired manipulation and the feel of the tissue below and around the needle upon insertion. A basic idea: Upper abdomen points are typically needled superficially (<.5"), but points on the gluteals and mid-thigh/knee area are often needled deeply (1-3"). However, it is important to remember that needle depth varies tremendously from practitioner to practitioner. Hope this helps. Luke643 (talk) 05:16, 10 February 2011 (UTC)

Good info. Can you find some verifiable sources for what you just wrote so you can put it in the practice section? PPdd (talk) 05:44, 10 February 2011 (UTC)

How are the "points" located? Are superficial anatomical structures used, and measurements from them taken, like "midway between such and such bone in the thumb, and so and so bone in the index finger? PPdd (talk) 05:44, 10 February 2011 (UTC)

How broad an area is allowed to be considered being on a "point"?

How does this vary from country to country? PPdd (talk) 05:44, 10 February 2011 (UTC)

PPdd, when you find out this information please write it in the book that you are clearly compiling. There is simply not the space in the article to detail or debunk acupuncture on this level. Famousdog (talk) 14:05, 10 February 2011 (UTC)

I got the idea about locating points and how broad and deep they are from your own "plethora" comment, which I thought was critical information lacking in the article which would make it readable. I actually shortened the lengthy "booklike article" by massively deleting all NRS material (except for disambiguating useages throughout the article, which I put in with RS so the article met MOS internal consitency requirements and became readable). But my deletion left the clinical practice and theory sections relatively empty. Four questions will make the science and other sections readable, since as it stands, the definition of where a point is and how it is located, how wide an area it covers, how deep it is, and how variable it is , seems to change all over the article, which throws the word "acupuncture" around, but with changing definitions, an inconsistency prohibited by MOS. When I came to the article, I could not read it because of all the shifting definitions and ambiguities. PPdd (talk) 14:34, 10 February 2011 (UTC)

Note that if you can't find it in a book, you should either remove it, or at the least not change it. Rather than Luke giving us the information and us having to trust him, we need a source to verify the information. Whatever the source says, that is the information we include. PPdd, this is again related to your approaching this as a puzzle to be solved, a research paradigm to be explored and a concept to be debunked (or at least examined critically). If you have questions about what a point is, that is something you look for off-wikipedia and if you find an answer, then you put it in. Most disputes can be settled by sources and you should be getting the details from books and articles in order to integrate them here. Editing articles really well takes a considerabl amount of time, simply because you need to read a lot of sources. I essentially wrote about 90% of the satanic ritual abuse article. It took me over a year, and I read all 15 books in the references section from cover to cover (or for the ones that didn't focus exclusively on SRA, the sections that did). Not to mention all the journal articles, and the crappy journal articles that got brought up on the talk page and were so shoddy or out of date that they never made it to the front page. When working on topics, I binge on information for months, gradually integrating what I can as I go along. To do this well takes considerable time, and I would suggest reading at least the abstracts of most of the articles before working with or summarizing them. Perhaps you have, if that's the case then you are a quick reader because your edits occur in extremely rapid succession and you've been keeping it up for days. Your intention is laudable, your efforts to work with other editors, accept criticism and respond is also laudable, but the normal hierarchy for page changes is always sources, policies, guidelines, manual of style, essays, then discussion and consensus on the talk page. WLU (t) (c) Wikipedia's rules:^simple/_complex 15:35, 10 February 2011 (UTC)

Understood. I tried not to make any changes except to clarify things already in the article, based on the cited RS. I think I only added a handful of new MEDRS and actual content additions, much less than I deleted as NRS. If Luke643 had provided a link to RS I could have read, I would have put in these minor additional content items to balance what I massively deleted as NRS, but I am wating to see RS on it first. I think this information with RS, and RS for Famousdog's comment in another section that locations of points vary so much that the whole body is effectively an acupuncture point would go a long way to making widely varying statements in the article more intelligable, at least it would for me. PPdd (talk) 15:51, 10 February 2011 (UTC)

I hope you do find RSs for this, PPdd, because clearing up this fundamental ambiguity would be useful. When I was researching chronic pain, every source seemed to have a different definition for the term, or didn't bother to define it. It took me several months to locate an RS that laid out the ambiguity, explaining the various usages. --Anthonyhcole (talk) 16:44, 10 February 2011 (UTC)

Yes, we share frustration. Reading the literature is very difficult because of all the abuse of ambiguities. Ambiguity of usage is the meat of alternative medicine. Never let a practicitioner hold the goal post for you. PPdd (talk) 17:08, 10 February 2011 (UTC)

point depths and locations are always defined anatomically. All the info on their location and depths, as practiced by most american acupuncturists, are laid out in this book: http://www.amazon.com/Fundamentals-Chinese-Acupuncture-Paradigm-title/dp/091211133X Luke643 (talk) 00:07, 11 February 2011 (UTC)

Thanks. I'm going over the online available parts. It answers many questions I had after reading the article. I cannot find anything on the diameter of a "point", i.e., how far out it extends, e.g., 1/2"?, 1"?, 2"?, etc. PPdd (talk) 00:20, 11 February 2011 (UTC)

Also keep in mind that there may not be a definition that is universally accepted or agreed-upon. Again, we are dealing with a prescientific concept from a culture that did not practice dissection and did not test the claims made using empirical research. Exact definitions are necessities for scientific research (and good scholarship in general) but we are not dealing with a technique which evolved through scientific research - it may have been simple bloodletting, and after the revolution in the 40s it went through a substantial political filter. This is not an excuse to impose a definition or even point out that one is lacking - unless you can find a source to substantiate it. Again, it is simply the reality of wikipedia and acupuncture research in general. WLU (t) (c) Wikipedia's rules:^simple/_complex 02:53, 11 February 2011 (UTC)

I found some RS on needle size and depth from Luke643's partially online source, and put it in practice sectoin. But you are likely correct that there is no totally uniform codes. I qualified the edits with "in U.S." PPdd (talk) 02:57, 11 February 2011 (UTC)

Acupuncture and evidence based surgery

I agree with Famousdog's edits' implied perspective that the article is very long and can use alot of paring down of dupicated content. So please get out your knives and cut away anything that is not evidenced by reliable sources, or just excess fat. PPdd (talk) 16:04, 10 February 2011 (UTC)

Blood flow, stagnation, blockage, flow channels

"Blood is a red liquid circulating in the vessels, and is a vital nutrient substance in the body." - Cheng, 1987, p. 48.

If "Blood" is "blood", then (1) why is it capitalized? This appears to be a MOS violation. I have read varioulsy that (2) Blood "propels itself", (3) Blood can "stagnate" and acupuncture treats this, (4) Blood vessels can suffer "blockage" and acupuncture treats this, (5) Blood can flow in the wrong "vessel" and acupunture treats this. In the context of the Cheng quotation, (6) is (2)-(5) believed to be literally true? PPdd (talk) 16:58, 13 February 2011 (UTC)

I keep reading about blockage of the flow of blood, and stagnation of blood flow, or blood flowing in the wrong channels. Is this a metaphoric flow? PPdd (talk) 00:56, 13 February 2011 (UTC)

Corrected title spelling, hope you don't mind.

It is more properly Blood, with a capital "B" but irrespective is not the red, physical blood that flows when a person is cut. I either read it in a source, or on acupuncture itself, but Blood is not physical blood, it is an energetic opposite to something. Might be the opposite of qi. So it's "energetic", but has nothing to do with actual energy (heat, electricity, light, kinetic impact, sound, radiation, magnetism, chemical, gravitational or any I've missed), it's related to the CAM concept of "energy". Which isn't talked about as if it were a real thing but is probably closer to metaphor than any other concept. WLU (t) (c) Wikipedia's rules:^simple/_complex 02:26, 13 February 2011 (UTC)

That definitely needs clarifying in the article. In TCM articles I have read, TCM "B"lood, has properties or something like "b"lood, then its back to anti-chi "B"lood, or something like that. Its very confusing. PPdd (talk) 02:37, 13 February 2011 (UTC)

"Blood is a red liquid circulating in the vessels, and is a vital nutrient substance in the body." - Cheng, 1987, p. 48. (Cheng is one of the main books that the NCCAOM exam is based upon; most states that acupuncturists pass the test in order to be licensed.) Blood is yin in nature and Qi is yang. So TCM Blood is physical but has TCM-esque functions. You'll find that other introductory TCM texts say the same thing. "Blood Stagnation" frequently refers to two distinct concepts (one being pain that is fixed in location, the other palpable masses in the body that shouldn't be there in a healthy body). Sloppy translation is often a problem.

PPdd, why are you biting off so much more than you can chew in attempting to coordinate a major rewrite in an area about which you know little? Relying on other editors who don't know how little they know won't help. --Middle 8 (talk) 05:05, 13 February 2011 (UTC)

Thank you for the clarification. One should not have to have a belief in supernatural forces to read an article, so clarification or disambiguation is needed. If "Blood" is "blood", then (1) why is it capitalized? This appears to be a MOS violation. I have read varioulsy that (2) Blood "propels itself", (3) Blood can "stagnate" and acupuncture treats this, (4) Blood can suffer "blockage" and acupuncture treats this, (5) Blood can flow in the wrong "vessel" and acupunture treats this. In the context of the Cheng quotation you provide, (6) is (2)-(5) believed to be literally true? PPdd (talk) 13:04, 13 February 2011 (UTC)

@PPdd: TCM's "xue", or "Blood", is capitalized as a convention to distinguish it from anatomical blood. Some authors have tried to just call it "xue" and leave it untranslated (like yin, yang and qi), but the capitalization as "Blood" (along with capitalization of the zang-fu, even the "Spleen" which has nothing to do with the anatomical spleen) is near universal in the English-language TCM literature. Why not read The Web That Has No Weaver, at a minimum, before trying to coordinate a massive rewrite? Do you really think that TCM is so useless that it doesn't matter whether you get it right as long as you manage to portray it as wrong?

Answering your other questions is like being an unpaid TCM tutor, and that's not my thing, sorry. Good luck; there are other editors you can ask. OK, so you may not get a correct answer, but no big deal; Wikiality goes with the territory. Have fun! And don't let your faith in your mission to improve the article (by Wikipedia's special standards) waver! --Middle 8 (talk) 14:36, 13 February 2011 (UTC)

Being "unpaid" at Wikipedia is part of the process. Being a "tutor" providing RS is helpful and much better than interminable long winded talk page discussions arguing semantics because of ambiguities, which has resulted in a massive archive for this article, with the same discussion over and over. PPdd (talk) 16:58, 13 February 2011 (UTC)

@PPdd: Sorry, I'm not trying to be a dick, but answering your questions properly involves more typing than I have time for, *and* I certainly can't keep up with your rapid-fire approach, *especially* with the persistent subtext of "TCM is complete and utter bullshit" and the "gotcha" tone of some of the questions you've asked in other sections. Just check out Kaptchuk's "Web" or Maciocia's "Foundations of Chinese Medicine" or Wiseman et. al.'s "Fundamentals of Chinese Medicine" (Paradigm Publications; it uses a consistent translation system [32]) or something like that. I'll give you some brief answers to your questions on Blood that may need further unpacking. Basically, Blood is Yin in nature and Qi is Yang. Qi moves the Blood, but Blood is also "mother of the Qi", i.e., necessary in making more Qi from food and air. So stagnation of Blood can result from a blockage or from not enough Qi (think of Qi as gasoline and Blood as tanker trucks that deliver it; now imagine a gasoline shortage so severe that the tanker trucks run out of gas on the freeway, causing a traffic jam: that is Stagnation due to Deficiency. Note how all I'm tending to capitalize other English translations of specific TCM terms; that again is a convention that predates Wikipedia'a MOS.)

So, the answer to your (2) above is no, Qi propels the Blood. (3): yes, to an extent. There are two kinds of "stagnation"; one refers to fixed pain and the other to fixed, palpable masses i.e. tumors. Acupuncture can't treat all of those, obviously. (4): I suppose yes; again, translation gets messy. I'd need to know whicb translation system was being used; ideally Nigel Wiseman's. (5) I need more context and reference to original Chinese terms to answer that.

I hope that helps. PPdd, would you mind answering my question that you didn't answer above, and I'm not being ironic: why are you biting off so much more than you can chew in attempting to coordinate a major rewrite in an area about which you know little? (Relying on other editors who don't know how little they know won't help.) regards, --Middle 8 (talk) 20:41, 13 February 2011 (UTC)

I am qualified to write on medical articles. I was at Stanford for 11 years doing medical study data analysis and philosophy of science. I was recently asked to help on anthroposophical medicine, which I had never heard of. I essentially blanked the entire arrticle as NRS, to yells and screamsfrom all sides. Then I put in science stuff from journals with MEDRS... and half the yells and screams went away. Then I got cooperation from people who believed in and had studied the AM field, and I added more on theory and practices and beliefs of practioners. I ended up with this[33], and then from an anthro med practitioner this[34], and the article has basically been stable and essentially unchanged ever since. So I ask that you please assume WP:GF, have patience, help with disambiguating and RSing proposed content, and help with the to-do list at the top of this page. Most of these talk page discussions are about avoidable ambiguities, and a lack of cooperation finding RS to add more into the article about theory and practice. PPdd (talk) 22:21, 13 February 2011 (UTC)

Well, I wish you luck, and no kidding, I'm glad you have something to work on that you enjoy. If I were you I'd channel it toward something different, but that's a matter of preference. I don't have faith in Wikipedia, and less time to be editing, so I can't commit to anything significant. But if I can find a way to help, and things seem to be moving in a good direction, I'll try to improve it. On a meta-level, I think your attitude is positive, and I agree that it is much better to try to make involved parties happy rather than annoyed. I'm not sure it's possible, especially with some of the "skeptic" types who are among the most wildly bad-faith-assuming, and WP:CIVIL and WP:HARASS, violators in town. Could be their cynicism toward some editors has rubbed off on me: I don't think Wikipedia is, in general, an environment conducive to what you are trying to attempt. All it takes is a few bad apples. Anyway, good luck, and I salute your idealism, with no irony -- it's Wikipedia itself that I scorn, and I believe that it takes advantage of people like you (follow the money; there are obvious conflicts of interest with for-profit Wikia). But maybe you'll at least enjoy yourself here. Put it this way: on WP, it takes a lot of "enthalpy" (editorial attention) to overcome the "entropy" (tendency toward wikiality, and the related issue of problem editors tending to drive away good ones). cheers, Middle 8 (talk) 03:29, 14 February 2011 (UTC)

^ Acupuncture compared with placebo in post-herpetic pain, Pain, Volume 17, Issue 4, December 1983, Pages 361-368, George T. Lewith , a, Jennifer Fielda and David Machina
^ Zhen Jiu Xue, p. 177f et passim.

[1] Acupuncture compared with placebo in post-herpetic pain, Pain, Volume 17, Issue 4, December 1983, Pages 361-368, George T. Lewith , a, Jennifer Fielda and David Machina

[2] Zhen Jiu Xue, p. 177f et passim.

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