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LETTER |
Allison Atwood and Esther M. Sternberg are with the National Institutes of Mental Health, National Institutes of Health, Bethesda, Md. Elizabeth Fee is with the History of Medicine Division, National Library of Medicine, National Institutes of Health, Bethesda, Md. Theodore M. Brown is with the Departments of History and of Community and Preventive Medicine at the University of Rochester, Rochester, NY.
Correspondence: Requests for reprints should be sent to Elizabeth Fee, PhD, Bldg 38, Room 1E21, 8600 Rockville Pike, Bethesda, MD 20894 (e-mail: elizabeth_fee{at}nlm.nih.gov).
The article to which Ulett is responding took a historical perspective, and the biological issues he raises are somewhat tangential to the point of the original. Nonetheless, we believe that he is incorrect in stating that there is no validity to ancient Chinese approaches to the practice of acupuncture. Indeed, the very references he cites strongly support the biological basis for acupuncture, over and above a nonspecific placebo effect. Thus, 2 of the references he cites1,2 and others by the same authors3,4 indicate that both neuropeptides and growth factors are released centrally in response to electrical acupuncture, and specific neuroendocrine systems are also activated by electrical stimulation. Ulett neglects to cite other work by the same authors showing that stimulation of specific acupoints results in activation of specific brain regions as detected by functional magnetic resonance imaging, while stimulation of points 2 to 5 cm distant does not5 (see also review by Cho et al.6).
From this developing literature there appear to be several underlying biological mechanisms by which acupuncture might exert its effects—some specific to the location of the acupoints and others specific to the method used, whether pressure, needle, or electrical. In the case of electrical stimulation, frequency of stimulation rather than location may be a stronger inducer of some neuropeptides and growth factors, as Ulett suggests. However, this does not negate the importance of the location of the points, as shown in other studies of needle use alone.5,6
Finally, some of the effects of acupuncture may also be related to general nonspecific placebo effects. This should not detract from the value of the method when it is used appropriately as an adjunct to medical therapy. Most medical treatments derive at least some of their benefits from the placebo effect. Indeed, the neuroendocrine and neural basis of the placebo effect is an important area of study to elucidate the many ways in which the central nervous system regulates other defense systems in the body.7 In this regard, we agree with Ulett that the biological basis of this form of therapy certainly should be further studied to inform its judicious use in the Western medical armamentarium.
References
1. Han JS. The Neuro-chemical Basis of Pain Control by Acupuncture. China: Hu Bei Technical and Science Press; 1998.
2. Cho ZH, Fallon J, Wong EK. Neuro-Acupuncture, Vol. I: Basic Neuroscience. Los Angeles, Calif: Q-Puncture Inc; 2001.
3. Han JS. Acupuncture: neuropeptide release produced by electrical stimulation of different frequencies. Trends Neurosci. 2003; 26:17–22.[ISI][Medline]
4. Liang XB, Liu ZY, Li FQ, et al. Long-term high-frequency electro-acupuncture stimulation prevents neuronal degeneration and up-regulates BDNF mRNA in the substantia nigra and ventral tegmental area following medial forebrain bundle axotomy. Brain Res Mol Brain Res. 2002;108:51–59.[Medline]
5. Cho ZH, Chung SC, Jones JP, et al. New findings of the correlation between acupoints and corresponding brain cortices using functional MRI. Proc Natl Acad Sci U S A.1998; 95:2670–2673.
6. Cho ZH, Oleson TD, Alimi D, Niemtzow RC. Acupuncture: the search for biologic evidence with functional magnetic resonance imaging and positron emission tomography techniques. J Altern Complement Med. 2002;8:399–401.[ISI][Medline]
7. Eskandari F, Sternberg EM. Neuroendocrine mediators of placebo effects on immunity. In: Guess HA, Kleinman A, Kusek JW, Engel LW, eds. The Science of the Placebo. London, England: BMJ Books; 2002:169–182.
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