Some people swear that regular sessions of acupuncture help relieve their back pain and headaches. And now there’s evidence they may be right.
In a study published in the Archives of Internal Medicine, researchers led by Andrew Vickers, an epidemiologist and biostatistician at Memorial Sloan Kettering Cancer Center, report that acupuncture is effective in reducing people’s chronic pain — more so than standard pain treatment and slightly better than using sham needles, suggesting that the benefits of real acupuncture are due to something more than the placebo effect.
The findings counter those of the last large study on the subject, which found that the needle technique was no better than a fake acupuncture treatment — using random pricking with toothpicks — in reducing people’s pain. But Vickers says his meta-analysis of the data, in which researchers reviewed 29 previous studies involving 17,922 participants, does a few things the previous studies did not. For one, he and his colleagues began by looking at only the most rigorous trials involving acupuncture and pain relief — those that directly compared acupuncture treatment with some type of sham needle therapy in which needles were either inserted only superficially or placed in locations that are not known by acupuncture standards to be key treatment points in the body. The authors of the analysis contacted each of the researchers on the previous studies to discuss with them how they separated the two treatment groups. By limiting their review to the most robust studies published, the authors could assess with more confidence acupuncture’s true effect on participants’ reports of pain before and after treatment.
Next, rather than simply summing up the total effect of acupuncture reported by researchers in previous studies, Vickers’ team asked for their raw data on individual participants’ self-reports of pain. Not all scientists use the same scale for reporting results, which makes it difficult to compare and consider such measurements of pain as a whole. With the raw data, Vickers and his team were able to standardize the participants’ responses and compare them in a more meaningful way.
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The result was a clear and “robust” effect of acupuncture in relieving chronic pain in the back, neck and shoulders, as well as pain due to osteoarthritis and headaches, Vickers’ team found. Compared with people undergoing sham needle treatments, those receiving acupuncture reported drops in back and neck pain of 0.23 standard deviations, and of 0.55 standard deviations compared with those not using acupuncture at all. On a pain scale of 0 to 100, that meant that among the participants, who started out with an average baseline pain score of 60, pain ratings fell to 30 on average for those who got acupuncture, 35 for those who received fake acupuncture, and 43 for people who got usual care and no acupuncture.
“The effects of acupuncture are statistically significant and different from those of sham or placebo treatments,” says Vickers. “So we conclude that the effects aren’t due merely to the placebo effect.”
Acupuncture is an ancient Chinese remedy for a curing a host of chronic ills, from headaches to back pain and menstrual cramps. The practice, like all medical traditions from the East, is built on the concept of maintaining the balance of various body elements — including blood and nutrients along with less measurable ones like the energy force known as chi. Inserting needles at designated point on the body is supposed to intercept or unblock the flow of such elements, and lies at the heart of the centuries-old therapy of acupuncture.
However, these theories are completely foreign, even weird, to Western medicine, which has a harder time accepting unquantifiable entities such as chi. That’s why Western researchers have struggled not only to document objective evidence of acupuncture’s effectiveness, but also to provide some hints about how it may work.
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Some doctors say the needles may release endorphins, the pleasure-inducing, painkilling chemicals that saturate the brain and numb pain signals. But such theories can’t fully explain why acupuncture patients say their chronic pain episodes become less frequent and less intense over time, with regular, long-term sessions. Some say the benefits of acupuncture are purely in the mind, a psychological placebo effect. But either way, for many pain patients, acupuncture does provide palpable relief.
Asks Dr. Andrew Avins in a commentary accompanying the study, if the treatment works, does it really matter whether the effect is physiological or psychological? “At least in the case of acupuncture, Vickers et al have provided some robust evidence that acupuncture seems to provide modest benefits over usual care for patients with diverse sources of chronic pain,” he writes. “Perhaps a more productive strategy at this point would be to provide whatever benefits we can for our patients, while we continue to explore more carefully all mechanisms of healing.”
In other words, if it works and doesn’t seem to lead to any harms, getting stuck with needles may not be such a weird idea after all.
Alice Park is a writer at TIME. Find her on Twitter at @aliceparkny. You can also continue the discussion on TIME’s Facebook page and on Twitter at @TIME.
(一) 飲食治療
所有糖尿病人均需遵從飲食治療。不同人士的熱量需要有別，患者宜諮詢註冊營養師設計適合自己的飲食餐單，以助控制病情，穩定血糖。一般原則如下：
(1) 均衡飲食，定時定量，以「少食多餐」為原則，有助穩定血糖。
(2) 適量進食含碳水化合物之食物(包括五穀類、根莖類蔬菜、水果、奶品類)。
> 一份五穀類(10克醣質) = 1滿湯匙白飯 / 米粉/上海麵(熟) 1/5碗 / 潮州粥 1/3碗 / 通粉/意大利粉(熟) 1/3碗 / 方包 1/2片(去邊) / 麥皮(熟) 1/2碗
* (一碗 = 300毫升中號飯碗)
> 一份根莖類蔬菜(10克醣質) = 1隻雞蛋體積之薯仔/蕃薯 / 2隻雞蛋體積之南瓜/蓮藕
> 一份水果(10克醣質) = 細蘋果/橙/柑/梨/奇異果1個/ 大蘋果/橙1/2個 / 小提子10粒 / 香蕉1/2隻
> 一份奶品類(12克醣質) = 低脂/脫脂牛奶240毫升/ 脫脂奶粉4平湯匙
Q:我是一名28歲家庭主婦，育有一歲半大兒子，生育後肚皮和面龐一直瘦不下來，美容院游說我做通淋巴治療，費用要萬多元，說通淋巴後便可回復生育前的舊觀，本人很想嘗試，與先生商量後，他着我寫信問問你才決定，故有勞你給我一些專業意見，也許若到醫生處接受通淋巴，價錢會否一樣，還是會貴些呢？ 駱太 上
A:通淋巴是美容界常濫用的名詞，特別用於誇大按摩效用，或標榜某類儀器具卓越排毒功能，甚至連組織上的毒素也可由淋巴排走，聽來似有道理，事實毫無醫學根據。
人體內血液循環先由心臟帶出，經大血管（大動脈）再輸送到中血管、小血管，再到微絲血管，此時血液內的養料、營養物、氧氣及水分等會由血管壁滲透到細胞去，細胞經新陳代謝作用產生的廢物，再回收到血管內，經小靜脈、中靜脈及大靜脈，再回流到心臟淨化，淨化後又變回新鮮血液再循環。
那麼，淋巴是扮演甚麼角色呢？原來有部分細胞外水分和廢物是由淋巴輸導管負責收集，且將它帶回血液循環系統，可以說是血液循環系統的一小支流。這些淋巴液由於不含紅血球，故呈無色，是輔助血液循環夥伴，作用有如去水管，在正常情況下是不會受阻塞，除非有炎症或癌變才會出問題，卻不能以食療或直接在淋巴位置做手術改善，必須清除相關的炎症，或切去相關惡性腫瘤，才能使淋巴組織回復正常功能。
人體假若沒有感染炎症或患惡性腫瘤，淋巴應暢通無阻，假如患上了頑疾，也決非美容師會懂得治療，必須由專科醫生來做手術，美容師的建議並非正確，有誤導嫌疑。
陸宏隆 覆
