750
BIOLPSYCHIATRY 1992;3!:749-754
Correspondence
Table 1. Plasma and Red Cell Tin Concentrations (Mean ng/ml SD) in Patients with Probable Alzheimer's Disease (AD), Multiinfarct Dementia (MID), Mixed Dementias, and Controls
Plasma Sn Red cell Sn
AD
MID
Mixed
Control
2.56 0.89 3.80 1.76
1.47 0.55a 2.36 0.95a
1.43 0.66a 2.41 0.51"
1.38 0.52" 2.58 0.80a
Statisticalanalysiswas by Mann-WhitneyU test and two-tailedprobability. aDifferen!fromAD at p < 0.05.
References Corrigan FM, van Rhijn AG, Ijomah G, Mclntyre F, Skinner ER, Hortoban DF, Ward NI, 43/4 (229-238) 1991: Tin and fatty acids in dementia. ProstaglandinsLeukot Essential Fatty Acids. Corrigan FM, Henderson AK, Van Rhijn AG, Coulter F, Horrobin DF, Ward Nl 8/4 (I 99-210) !991: Serum con¢engrations of bromine and tin in hypertension and depression. Trace Elements in Medicine. Earley B, Biegon A, Leonard BE (1989): Quantitative autoradiographic analysis of muscarinic receptors and
The Myth of Meridian Therapy To the Editor: The U.S. has now had two decades of experience with acupuncture. Where do we stand today? Since this journal last took note of this subject (Ulett 1988), the field has expanded rapidly in two directions, fact and fantasy, science and cultism, The term 'acupuncture" has become the umbrella for a number of treatments in addition to the ancient traditional practice of placing needles and manually twirling them in some of the several hundred so-called acupuncture points. It includes auricuiotherapy, moxibustion, and acupressure, as well as the electrical stimulation of surface electrodes on acupuncture points. Widely accepted metaphysical explanations for the 3,000 year old practice are still commonly believed. These explanations for altering body energies traveling in imaginary channels are now widely accepted as the basis for a number of healing cults. Re.flexologists believe that these mythical meridians conduct fancied energy impulses from the feet.
quantitative histochemistryof acetylcholineresterasein the rat brain after trimethyi tin intoxication. Neurochem Int 15:475-483. Gautrin D, Gauthier S (1989): AIzheimer's disease: Environmental factors and etiologic hypotheses. Can J Neu. rol Sci 16:375-387, McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan E (1984): Clinical diagnosis of Alzheimer's disease: Report of the NINCDS/ADRDA Work Group under the auspices of Departmentof Health and Human Services Task Force in AIzheimer's disease. Neurology 34:939-944.
where all organs of the body are supposedly represented. Auriculotherapists similarly view the ear. There are scalp.needling therapists, Korean hand acupuncturists, tongue acupuncturists and over 125 other types. Homeopaths, naturopaths, massage healers, laser therapists, kinesiologists, color therapists, Qi Gong experts, magnetic therapists, practitioners of Ryodoraku, traditional Chinese medicine, and other "holistic" and "probioti¢" practitioners use the meridian concept. Such claims carry the added charisma of the mysterious orient, and thus are able to produce a strong placebo rate of success. Upon this, placebobased reputation, the meridian therapies flourish. With current increasing interest in "alternative medicine" (Time, Newsweek, etc.) these practices are on the increase. The lack of a proven scientific basis for such procedures has been no hindrance to the licensing of persons as "acupuncturists" in 22 states, up from 13 in my previous, 1988 communication. Increasing numbers of nonmedical persons are acting in the role ~,: " ' p ~ r y physician." One group, the American
Correspondence
Association of Acupuncture and Oriental Medicine, claims a membership of over 6,000 and is actively lobbying for recognition by the Food and Drug Administration, and Medicare and other third-party payers. Opposing such action is the National Council Against Health Fraud, stating that acupuncture has no physiologic basis and is simply a placebo (Clin J Pain 1991). From the forgoing it might appear that any physician with scientific medical training woul0 be justified in completely rejecting acupuncture as a practice unworthy of serious attention. To do so, however, might well lead to the neglect of what may be an important avenue for patient care. Concurrently, with the growth of cultic acupuncture, there has also been, in this decade of the brain, increasing understanding about the neurophysiology of pain. Following Melzac and Wall's introduction of the gate theory, came increased knowledge of the neural pathways involved in pain perception, the neurophysiology of pain control mechanisms and the widespread use of TENS units in pain control. We can now view the metaphysics of traditional acupuncture as an important antecedent development in the history of medicine, one stone in the foundation of the specialty of algology. It is upon these formulations, developed in preseientific times, that Han and others have constructed a series of experiments that have resulted in a scientifically tenable explanation of how electrical stimulation can activate the body's own antinociceptive mechanisms (Han 1987). in other words, metaphysical acupuncture has now been replaced by scientifically based neumelectric stimulation. Work in the early 1970s demonstrated that the use of electricity greatly increases the effectiveness of acupuncture in the treatment of experimental pain, raising the results, from using needles alone, significantly above the placebo level. Instead of using some 365 points along mythical meridian channels, we now use primarily the motor points of electromyography (Ulett 1989). Han has shown that acupuncture is frequency specific and not point specific. By stimulation of a single
BIOL PSYCHIATRY 1992;31:749-754
751
point, without moving the electrode but using either a low (2-4Hz) or a high (100Hz) frequency he has demonstrated a rise in either endorphins or dynorphins. He has shown this not only in animals (Han 1990) but also by monitoring peptide levels in the spinal fluid in human volunteers. He has also demonstrated the role of CCK as an endogenous antiopioid substance (Hart and Shao 1990). CCK can effectively lower pain threshold. The interaction between CCK and endorphins occurs at both receptor level and intracellular transduction pathways. E~cessively prolonged neuroelectric stimulation can apparently increase CCK production and release, a~d thus affect homeostatic balance within the pain-control mechanism. Again we bow to the perceptive wisdom of the ancient Chinese physicians with their concept of yin/yang. For we now recognize that there is an agonist/antagonist action within the nociceptive system of the central nervous system! George A. Ulett
Missouri Institute of Mental Health University of Missouri-Columbia 5247 Flyer Ave. St. Louis, MO 63139-1494
References Editor (1991): Acupuncture: The position paper of the National Council Against Health Fraud. Clin 3 Pain 7:162166. Him JS (1987): The Neurochemtcal Basis of Pain Relief by Acupuncture. A collection of papers, 1973-1978. Beijing Medical University, Beijing, China. Han JS Shao LS (1990): Differential release of encephalin and dynorphin by low and high frequency electmacupuncture in the central nervous system. Acupuncture: The Scient~c International Journal (I): I-9, (2): 1927. Ulett GA (1988): Acupuncture update. An editorial. Biol Psychiatry 24.247-248. Ulett GA (1989): Scientific acupuncture: Peripheral electrical stimulation for the relief of pain. Pain M¢nage. merit (!): 128-134, (2): 185-189.
BIOLPSYCHIATRY 1992;3!:749-754
Correspondence
Table 1. Plasma and Red Cell Tin Concentrations (Mean ng/ml SD) in Patients with Probable Alzheimer's Disease (AD), Multiinfarct Dementia (MID), Mixed Dementias, and Controls
Plasma Sn Red cell Sn
AD
MID
Mixed
Control
2.56 0.89 3.80 1.76
1.47 0.55a 2.36 0.95a
1.43 0.66a 2.41 0.51"
1.38 0.52" 2.58 0.80a
Statisticalanalysiswas by Mann-WhitneyU test and two-tailedprobability. aDifferen!fromAD at p < 0.05.
References Corrigan FM, van Rhijn AG, Ijomah G, Mclntyre F, Skinner ER, Hortoban DF, Ward NI, 43/4 (229-238) 1991: Tin and fatty acids in dementia. ProstaglandinsLeukot Essential Fatty Acids. Corrigan FM, Henderson AK, Van Rhijn AG, Coulter F, Horrobin DF, Ward Nl 8/4 (I 99-210) !991: Serum con¢engrations of bromine and tin in hypertension and depression. Trace Elements in Medicine. Earley B, Biegon A, Leonard BE (1989): Quantitative autoradiographic analysis of muscarinic receptors and
The Myth of Meridian Therapy To the Editor: The U.S. has now had two decades of experience with acupuncture. Where do we stand today? Since this journal last took note of this subject (Ulett 1988), the field has expanded rapidly in two directions, fact and fantasy, science and cultism, The term 'acupuncture" has become the umbrella for a number of treatments in addition to the ancient traditional practice of placing needles and manually twirling them in some of the several hundred so-called acupuncture points. It includes auricuiotherapy, moxibustion, and acupressure, as well as the electrical stimulation of surface electrodes on acupuncture points. Widely accepted metaphysical explanations for the 3,000 year old practice are still commonly believed. These explanations for altering body energies traveling in imaginary channels are now widely accepted as the basis for a number of healing cults. Re.flexologists believe that these mythical meridians conduct fancied energy impulses from the feet.
quantitative histochemistryof acetylcholineresterasein the rat brain after trimethyi tin intoxication. Neurochem Int 15:475-483. Gautrin D, Gauthier S (1989): AIzheimer's disease: Environmental factors and etiologic hypotheses. Can J Neu. rol Sci 16:375-387, McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan E (1984): Clinical diagnosis of Alzheimer's disease: Report of the NINCDS/ADRDA Work Group under the auspices of Departmentof Health and Human Services Task Force in AIzheimer's disease. Neurology 34:939-944.
where all organs of the body are supposedly represented. Auriculotherapists similarly view the ear. There are scalp.needling therapists, Korean hand acupuncturists, tongue acupuncturists and over 125 other types. Homeopaths, naturopaths, massage healers, laser therapists, kinesiologists, color therapists, Qi Gong experts, magnetic therapists, practitioners of Ryodoraku, traditional Chinese medicine, and other "holistic" and "probioti¢" practitioners use the meridian concept. Such claims carry the added charisma of the mysterious orient, and thus are able to produce a strong placebo rate of success. Upon this, placebobased reputation, the meridian therapies flourish. With current increasing interest in "alternative medicine" (Time, Newsweek, etc.) these practices are on the increase. The lack of a proven scientific basis for such procedures has been no hindrance to the licensing of persons as "acupuncturists" in 22 states, up from 13 in my previous, 1988 communication. Increasing numbers of nonmedical persons are acting in the role ~,: " ' p ~ r y physician." One group, the American
Correspondence
Association of Acupuncture and Oriental Medicine, claims a membership of over 6,000 and is actively lobbying for recognition by the Food and Drug Administration, and Medicare and other third-party payers. Opposing such action is the National Council Against Health Fraud, stating that acupuncture has no physiologic basis and is simply a placebo (Clin J Pain 1991). From the forgoing it might appear that any physician with scientific medical training woul0 be justified in completely rejecting acupuncture as a practice unworthy of serious attention. To do so, however, might well lead to the neglect of what may be an important avenue for patient care. Concurrently, with the growth of cultic acupuncture, there has also been, in this decade of the brain, increasing understanding about the neurophysiology of pain. Following Melzac and Wall's introduction of the gate theory, came increased knowledge of the neural pathways involved in pain perception, the neurophysiology of pain control mechanisms and the widespread use of TENS units in pain control. We can now view the metaphysics of traditional acupuncture as an important antecedent development in the history of medicine, one stone in the foundation of the specialty of algology. It is upon these formulations, developed in preseientific times, that Han and others have constructed a series of experiments that have resulted in a scientifically tenable explanation of how electrical stimulation can activate the body's own antinociceptive mechanisms (Han 1987). in other words, metaphysical acupuncture has now been replaced by scientifically based neumelectric stimulation. Work in the early 1970s demonstrated that the use of electricity greatly increases the effectiveness of acupuncture in the treatment of experimental pain, raising the results, from using needles alone, significantly above the placebo level. Instead of using some 365 points along mythical meridian channels, we now use primarily the motor points of electromyography (Ulett 1989). Han has shown that acupuncture is frequency specific and not point specific. By stimulation of a single
BIOL PSYCHIATRY 1992;31:749-754
751
point, without moving the electrode but using either a low (2-4Hz) or a high (100Hz) frequency he has demonstrated a rise in either endorphins or dynorphins. He has shown this not only in animals (Han 1990) but also by monitoring peptide levels in the spinal fluid in human volunteers. He has also demonstrated the role of CCK as an endogenous antiopioid substance (Hart and Shao 1990). CCK can effectively lower pain threshold. The interaction between CCK and endorphins occurs at both receptor level and intracellular transduction pathways. E~cessively prolonged neuroelectric stimulation can apparently increase CCK production and release, a~d thus affect homeostatic balance within the pain-control mechanism. Again we bow to the perceptive wisdom of the ancient Chinese physicians with their concept of yin/yang. For we now recognize that there is an agonist/antagonist action within the nociceptive system of the central nervous system! George A. Ulett
Missouri Institute of Mental Health University of Missouri-Columbia 5247 Flyer Ave. St. Louis, MO 63139-1494
References Editor (1991): Acupuncture: The position paper of the National Council Against Health Fraud. Clin 3 Pain 7:162166. Him JS (1987): The Neurochemtcal Basis of Pain Relief by Acupuncture. A collection of papers, 1973-1978. Beijing Medical University, Beijing, China. Han JS Shao LS (1990): Differential release of encephalin and dynorphin by low and high frequency electmacupuncture in the central nervous system. Acupuncture: The Scient~c International Journal (I): I-9, (2): 1927. Ulett GA (1988): Acupuncture update. An editorial. Biol Psychiatry 24.247-248. Ulett GA (1989): Scientific acupuncture: Peripheral electrical stimulation for the relief of pain. Pain M¢nage. merit (!): 128-134, (2): 185-189.
