Acupuncture study on hypertension

A new study regarding the effect of acupuncture and hypertension has recently been published in Circulation .As studies dealing with alternative modalities go, it is better designed than most. In essence, it concludes that acupuncture as practiced in Traditional Chinese Medicine (TCM) can reduce non complicated hypertension, actually approaching the effect of hypotensive drugs such as angiotensin. The authors state that acupuncture can be used as an adjunct or alternative to other forms of lowering blood pressure, and provides a promising avenue for a malady where management through more routine methods are either costly or are difficult to comply with.

As time passes, the merits and weakness of this study will be added to the general data base regarding acupuncture and whatever positive or negative contribution it offers will be duly assimilated. In the mean time, Orac provides interesting commentary and presents a series of concerns regarding the study. Overall, he states that even if there are some benefits to needling, the actions are likely due to physiological mechanisms not linked to the philosophies and beliefs of acupuncture and TCM.

“More specifically, if acupuncture has any real effects on pain or other medical conditions, it doesn't do it by altering any sort of mystical and unmeasurable "life energy." If there is a physiologic effect of acupuncture, it must derive from human physiology, not magic, be it placebo effect, release of endorphins, or a counter-irritant effect, all of which have been postulated by various investigators as possible mechanisms for whatever clinical effects have been reported for it. Whatever the true case is, the scientific method should be able to figure it out in time.”

This study is randomized but is single blinded in favor of the acupuncture physicians. That is, the Chinese physicians were not blinded. Admittedly this would be tough to do, but it opens the door to a potentially fatal bias possibly rendering any conclusions of the study pretty much dead on arrival. For example, the clinician’s formal demeanor and tactile skills in the context of the acupuncture application may have tremendous calming influence as well as other unexpected effects.

Additionally, the number and placement of needles may cause placebo/nocebo effects that may account for the variations in pulse values. It would be interesting to get more detail as to the exact placement and methodology beyond the text description as this may play an important role in psychological responses which can play an important role in relaxation or increased tension. For example, were the placements of the sham needles in more topically sensitive regions of the body? Because the study did reveal a response it would be prudent to do several follow up studies to improve the “definition” of the effect and build a larger body of evidence to better ascertain just what is being observed.

TCM philosophies have very little plausibility and reality based mechanisms of action. Additionally, there is a mounting data base of equivocal and negative results regarding acupuncture (There have been attempts to link neurophysiologic effects to putative regions of the body- not necessarily acupuncture points- especially using electricity, but even here many questions remain and at any rate they imply a different effect than acupuncture and needling). Allusion to the ancient wisdom of TCM implied in the study and acupuncture technique stands on very shaky ground historically. Therefore this is a case where just a little bit of evidence is not good enough.

Hypertension is variable and sensitive to environmental stimuli, and though these study results are interesting, the effects fall very closely into the natural waxing and waning variations that profile many chronic diseases even though the authors seem to have taken reasonable efforts to minimize many confounding factors. Incidentally, the study references an interesting article: “ Statistics Notes: Some examples of regression to the mean.” It is not clear that this phenomenon, among others, was clearly accounted for with respect to influencing the observations.

Also, though a tough situation for the authors, we need to take into account the possibility that the anti hypertensive medication played some confounding role. The study seems to have considered this issue, but the question still stands. Another point not clear is whether those monitoring blood pressure values were blinded as this can be another big problem when interpreting results a certain way.

In the background brief, the authors discuss the problems that western medicine has controlling hypertension mentioning pharmaceutical side effects, the cost of medication, and compliance problems regarding managing this condition. However, they also acknowledge in their conclusion that acupuncture training (implies cost), and compliance could be pivotal to the success or failure of acupuncture treatment. Interestingly they stress the importance that acupuncturist skill level plays in applying TCM based acupuncture correctly, adding a layer of obscurity to these results (i.e., the implication being that there is a "special" form of practicing needling that is hard to replicate, but that the chinese seem to possess in spades).

The problematic use of sham acupuncture as mentioned remains an issue. When the rubber hits the road, the act of needling seems to have some type of physiological effect, even if the body is simply reacting to a foreign body intrusion. Teasing out a proper control is difficult and placebo influence seems to pop up recurringly significantly confusing matters . Perhaps sensing some of the problematical issues in the study, the authors revealingly suggest that using acupuncture to manage hypertension may be best suited to those individuals that expressed an interest in the “spiritual” aspects of TCM and acupuncture.

Finally, it seems even the popular TCM practice of acupuncture continues to be riddled with basic foundational questions. Perhaps, one way or the other, improved quality research will offer more satisfactory answers. To rise above the background noise of random effects (as opposed to a clear specific point A that influences organ B) will take a significant number of higher quality studies. However, we need to keep in mind that there may come a point (pardon the pun) where effort and money spent researching modest effects in one modality could be better utilized in other areas of inquiry.

The Skeptics Dilemma

One of the major burdens for the skeptical mind is to remain vigilant against the ever looming shadow of biased tendencies and selective beliefs carried in some form and degree by all humanity. These are powerful and natural urges tempting one to create a form of pseudo-intellectual comfort zone or world view that provides a foundation for irrational positions and unfounded beliefs.

This almost instinctual urge seems to be an integral part of how we as humans interpret and process the world around us. Our evolutionary make up is geared towards a high level of social interaction and symbolic reference which, without constant critical inquiry, can lead even the most skeptical among us down exceedingly irrational realms of belief, perception, and interpretation.

Skeptics are not immune to the plethora of fallacious reasoning that so infects much of present day thinking. This can be a heavy burden for a skeptic as the fact is we need to acknowledge that at best, we can only strive to be the “ideal” skeptic- that is put everything to the test of skeptical analysis. Basically, one way or the other, because we are human, there will always be a level of selectivity and bias in our outlook.

That said this admission is the very saving grace of skeptical reasoning allowing it to progress, change, and grow toward reality. Being aware of these human mental limitations puts the skeptic in a better position to minimize the numbing effects of irrationality and correct errors in thinking as they are discovered. This critical methodology of self doubt and constant assessment therefore opens the door for the true nature of the world to reveal itself. This is a just reward for any aspiring inquirer.

An example of the struggle to achieve balanced skepticism can be found in the realm of modern medicine. To some extent technical science based medicines, in many cases, have not only excluded implausible therapies, but also some crucial human emotional needs that are integral to clinical practice. The classical bedside manner and the human touch seem to have been disregarded to a degree. Therefore, care must be taken not to throw away the baby with the bath water.

Without the human balance to “soften” modern medicine, we run the risk of losing much of the well deserved respect modern medicine has achieved to a chaotic realm of irrational thought (much of alternative medicine) that is now attempting to falsely claim the banner of “humanism” as uniquely theirs. The danger here is that many medical institutions seem to be over correcting by embracing inappropriate practices that have little to offer other than placebo effects and false hope. Medicine is a particularly human endeavor wrought with pitfalls and potential problems and provides a real world example of the care we as skeptics need to carry while advancing the goal of truth.

However, an even more crucial issue confronting medicine and balanced skepticism in general for that matter is the lack of critical thinking tools in today’s society, an especially egregious problem with respect to the education of our youth.

In a recent CSI (Committee for Skeptical Inquiry) newsletter, James Alcock writes: “Modern western societies have neglected the importance of teaching children the tools of critical thinking, while at the same time, popular culture has encouraged them to challenge every authority while treating their own opinions, informed or otherwise, as reliable sources of knowledge.”

For the skeptic, these are profound reminders of how easy it is to fall under the sway of inconsistent skeptism and intoxicating fallacious reasoning. Rinolo and Nisbet in the Skeptical Inquirer mention three fallacies that they considers most serious for skeptical thought: conformational bias, “confirming” evidence (the file drawer effect), and belief perseverance.

• Conformational bias: “We all look for evidence that is consistent with our beliefs….and do not seek out discrediting evidence with the same vigor that we look for supporting evidence.”

• “Confirming” evidence: “They (we) are apt to accept “confirming” evidence at face value while subjecting “dis confirming” evidence to critical evaluation.”

• Belief confirmation: “…studies have demonstrated that it can be difficult to change a belief even when substantial discrediting information is provided.”

These basic biases are commonly associated with uncritical thinking but also affect, at times, the best of skeptics. By taking into account these potential pitfalls and continually self-correcting, skeptical inquiry will continue to thrive as a healthy and robust enterprise giving humanity the best chance to discover and advance truth. As Rinolo and Nisbet conclude: "Self-knowledge concerning our limitations is useful in two ways: it encourages intellectual humility and honesty and it keeps the daunting task of not falling prey to our particular certainties forthrightly in view."

Ref:

Alcock, J. The appeal of alternative medicine. Skeptical Briefs. March 2007 vol(17), No.1

Rinolo, T, Nisbet, L. The myth of consistent skepticism. Skeptic Inquirer May/June 2007 vol (31) No.3

Quantization, wavelengths, and granular reality

When Victor-Louis de Broglie linked the wave nature of matter to the fundamental size and structure of atoms, the stage was set for quantum physics to enter a fantastic and bizarre realm of discovery. The realization that the wavelength of the electron determined an atoms size provided the seeds that led Max Born (through Schrödinger’s equation) to a startling conclusion. He realized that there was a connection between quantum wavelength distributions (probabilities) of electrons and their particulate behavior; that is wave-particle duality and wave-probability go together. The implications were enormous as the whole of quantum physics became probabilistic in nature. Additionally, here was a better way to probe the quantized or granular nature of reality.

This granular characteristic has roots in the very make up of reality itself. Probing the tiniest boundaries of existence, a place where the plank scale rules, it is possible to glimpse mysterious and fundamental interactions that ultimately describe this granular reality. For example, by observing the dynamic relationship between electrons and atomic nuclei we gain some understanding of the origins to this quantized or granular existence. Among the various complex quantum forces, these two seem to stand out together bound in eternal conflict. But one that results in the very reality we live in.

The kinetic energy of an electron searches out the lowest energy and “seeks” to expand out and away from the nucleus while the attractive force – the potential energy of the nucleus “pulls” at the electron. A balance is reached between these two forces and the electron spreads itself throughout this specified region (which turns out to be around 10^-10 m). As nuclei increase in size, they pull electrons closer to the nucleus thus forcing them into a higher kinetic state allowing “space” for more electrons to occupy up to a maximum region of balance (of charges). The last electron to fill the imbalance of forces will eventually fall into the same region as the electron of the smallest nucleus does (hydrogen)-10^-10m; hence all atoms are actually similar in size.

Ultimately, the balance between the kinetic energy of the electron and the potential energy of the atomic nucleus provide a natural backdrop from where quantum behavior can have wave like properties. As an electron distributes itself in three dimensions at the point of balance, its wavelength is “focused” or bound in an area around the nucleus. However, because of the diffuse distribution of a wave, even a fixed wave, it “oscillates” and behaves probabilistically. That is you can not readily localize it to one spot- it is nonlocal.

Interestingly, depending upon the electrons excitement the wavelength will oscillate around the nucleus at varying frequencies. For example, using the Hydrogen atom Kenneth Ford (The Quantum World) describes the resulting phenomena stating: “This behavior is reminiscent of the vibration of a violin string in its fundamental mode and in its higher harmonics. The lowest vibration frequency of a string held fixed at its two ends has one-half wavelength over the end of the string. The second harmonic is one in which there is a full wavelength over the length of the string…And so on. It is the nature of the rules governing sound that the second harmonic is twice the frequency of the fundamental…and so on…the frequencies of vibration of the violin string are quantized. A string of given length and tension vibrates only at a discrete set of frequencies.”

In essence, the observed quantization of atoms is, in some ways analogous to different lengths of vibrating waves with their combined set of specific frequencies. Schrödinger provided the equation that mathematically yielded the observed quantized energies, which thereby supported de Broglie’s wave-matter theory. This salient topic, from a quantum point of view, helps broaden ones perspective concerning the nature of reality and opens the way to ever stranger domains.

Ref Ford, K the quantum world. Havard Univ Press.Massachusetts, USA.2004

Altruism: from genes to primates

Interesting notes on primate altruistic behavior

As primates go, human societies have an incredibly complex, nuanced, and dynamic structure that sometimes makes beautiful sense and other times leaves you scratching your head. From very basic forms of gregarious behavior human society has evolved breathless levels of elaborate cooperative- and not so cooperative behavior.

This makes it difficult to pin down specific and clear cut correlations between person to person interactions making it even harder to formulate any generalized species specific behaviors for our “deep and brooding” ways. However, fascinating evolutionary theories regarding human social behavior have begun to shed light on why we do what we do.

The social behavior of other primate species can offer revealing insight into the workings of our own far more complex social structure as well as humble us with many of the startling similarities observed. Most primate species, like humans, live in large groups and generally maintain a familiar social pattern. The mother- infant bond acts as the primal social glue and from this core, a variety of social structures exist depending on what species is studied. In general primate group systems involve a core of matrilines (females and their female offspring) and males tend to migrate to other groups.Some primate species have a reverse make up such as chimpanzees and spider monkeys where the core of a group is male and the females do the migrating. In general though, all these large groups have relatively stable social make ups.

The significant migration between groups of individuals allows for a whole new world of complex interactions to flower. This added layer of behaviors between individuals are ultimately dependant on relatedness and give rise to wondrous primate versions of social interactions and altruistic behaviors opening the door to a broader understanding of the maddening quagmire that are the human social systems of today.

Through the work of J.B. Haldrane and later W.D. Hamilton (late 1950’s and early 1960’s) an evolutionary theory developed involving genetic continuity among groups. This provided an evolutionary basis for a variety of animal behaviors including primate altruism. This “genes eye” view of group behavior gave rise to a variety of theories that take into account genetic, biological, and sociobiological phenomena in group interactions and eventually coined the now familiar term "the selfish gene."

Obviously, this is a simplistic and anthropomorphosized description of natural gene to gene interactions. However, these genetic interactions do provide a framework for developing an evolutionary basis for many animal interactions and in this case, primate social behaviors.

Kin Selection and cooperation

Since the concept of kin selection was formulated (that related individuals come together in the interests of maintaining the survival of like genes in a gene pool) it has taken on a bit more nuance with respect to primate social behavior. Seemingly logical predictions turn out to be more complex than previously thought. The larger goal of genetic “selfishness” though still remains a core incentive.

For example, during fights animals regularly come to each others aid forming coalitions often between close genetic relatives. This simple concept can get rather complicated depending on the given circumstance. Female rhesus macaques are less likely to support even an ally closely related to them if the opponent is highly ranked. This seems to be a form of calculating the risk vs. benefits for offering aid and brings to mind very human traits and justifications such as “living to fight another day.”

One form of kin selection and altruism can be observed when older offspring fore go their breeding opportunities in order to help their parents raise a younger litter. This behavior seems to stem from crowded conditions and harsh environments where the benefits of passing like genes are weighed towards this “selfless” behavior.

Another interesting form of kin selection in primate social groups relates to male migratory behavior. Male vervet monkeys migrate into groups where older brothers or cousins have already migrated as they are more likely to support each other in conflicts and it may also be more likely to successfully integrate into the group.

Reciprocal altruism

This interesting behavior seems to be widespread among primate groups and involves cooperation between unrelated individuals where both parties exchange mutual benefits on a reciprocal base.

In one example, male baboons form coalitions for mutual protection against larger and more powerful males. Another example involves a seemingly “political” association where a low ranking male chimpanzee supported the second –ranking male against the top male permitting the second-ranking male to become dominant. The reward for the low-ranking male was access to receptive females he would otherwise not have access to- sound familiar?

Evolutionary stable strategies

This fascinating sociobiological concept, derived from game theory mathematics, offers a malleable and effective mechanism by which animals resolve conflicts. It predicts that given a choice an animal behaves in such a way as to achieve the most profitable situation- but what this is will vary depending on what the other individuals in the population are doing.

Dunbar (Human Evolution) gives this example: “…male gelada baboons acquire harems of females in two ways. One option is to fight a harem-holder so as to take over his entire harem…A second is to join another male’s unit as a subordinate follower without challenging his ownership; a follower can then build up relationships with one or two peripheral females who make a small harem that eventually separates off from the parent unit. The best strategy is clearly to take over an entire unit, because by doing so a male gains many more breeding females than he can as a follower. However, there are only a limited number of units in the population large enough to be worth fighting for. Consequently, as an increasing number of males opt to take over a unit, so a male’s tenure as harem- holder declines. Reproductive success depends not on just the number of females that a male can mate with …but also on the time over which he can do so. The initial advantage a male gains from taking over a large unit is hence soon offset by the fact he cannot survive very long as harem-holder. It then pays some males to become followers. A balance may be maintained between the two reproductive strategies…”

These interactions are not as simple as they might sound when extended to other primates, especially humans.It does, however offer a small glimpse of how complex human social behavior might come about. Incidentally, new inroads into understanding the intricate behaviors of human society are coming from expanding game theory experiments. They are providing insight into the curious interplay between human instinctive and cognitive interactions as well as on the balance between apparently rational and irrational behaviors.The discovery of incredibly complex “meta-rational” behaviors (where individuals skip over apparently rational choices and basic logic to make apparently illogical choices that in fact end up reaping even greater rewards) that ultimately benefit all involved parties is shedding new light on the deeper nuances of human society. This is reminiscent of the R. Dawkins “nice guys finish first” concept of mutual and cooperative behavior predominating in many evolutionary stable strategies.

In essence, by acknowledging the rich tapestry and variable nuances of primate social behavior, we as a species can begin to understand how and why we interact the way we do. This confirms to us the fact that we are inextricably and evolutionarily linked to our primate cousins- an appropriately humbling experience. Additionally, we are provided valuable information allowing perhaps for the discovery or reinforcement of more constructive forms of human interactions that may go a long way towards limiting our more destructive behaviors.

Ref:

R Dunbar.Social behavior and evolutionary theory. Human evolution. Cambridge Univ Press. UK.2005

non sequitor

Pulse diagnosis

A significant amount of alternative medical modalities have taken the tact of “integrating” into the arena of mainstream medicine claiming supposed "complementary" benefits. These modalities seek to legitimize irrational therapies by association with proven practices. This in itself poses tremendous problems. However, it is important to note that many alternative practitioners actually still utilize methods of examination that stray far from rational pathophysiological approaches with some claiming that: “All Chinese medical treatments such as acupuncture and herbal prescriptions use pulse diagnosis as a basis to formulate treatment methods specific to the individuals needs.”

The practice of pulse diagnosis literally bases its foundation on highly elaborate and archaic philosophical belief systems that often vary in detail depending on their regional and historical origins (i.e., Traditional Chinese Medicine or Ayurvedic Medicine). There is little reliable literature regarding this practice outside of a historical context though there have been attempts to develop a methodological approach to using them that rely on dubious assumptions. Many of these methodologies utilize the practice of manually palpating the radial pulse of an individual to diagnose a patient’s malady. Apparently, in the right hands, this diagnostic modality yields an immense amount of information regarding a patient’s condition and disease process, including their emotional and mental conditions:

“Any practitioner of traditional Chinese medicine (TCM) will tell you that the fine art of pulse diagnosis requires a combination of diligent study and innate talent. This essential diagnostic tool provides insight into the state of organ health, emotional and psychological functioning as well as concern for ones future health.”

The conceptual framework of pulse diagnosis seems to have different interpretations based upon a practitioner’s Traditional Chinese Medicme (TCM) schooling and unique personal impressions. "Modern" pulse diagnosis involves the palpation of the radial artery utilizing three specific fingers while applying varying degrees of pressure. The practitioner interprets the character of the pulse then diagnosis the patient’s problems drawing upon “energy flow” philosophies that describe nebulous associations of organs, energies, elemental qualities (heat, cold, wind, dampness…).

“In performing pulse palpation, the practitioner places the index, middle, and ring fingers on the radial artery. Three degrees of pressure, the light touch, the medium touch, and the heavy touch are applied to the region and correspond to the upper, middle, and lower areas of the body.

In traditional terms, there are 28 pulse classifications, which describe the way the pulse feels to the fingertip. Some examples of these classifications are:

• Slippery - feels like a rolling pearl in a basin, very fluid and full
• Choppy - has no strength and is irregular
• Full - large and rounded, can be felt at all levels
• Empty - hard to detect or felt only slightly at the superficial level when pressure is applied
• Slow - slower than the normal rate of four to five beats per breath
• Rapid - six to seven beats per breath
• Superficial - easily felt on the skin surface
• Deep - only felt with a heavy touch”

These palpation techniques were apparently far more elaborate in the past, but have been simplified, perhaps to satisfy the needs of western practitioners:

“Originally, pulses were felt at various locations, three on the head, three on the each arm and three on each leg. However, in modern times, the majority of TCM practitioners perform a simplified version which examines three finger positions at three depths referred to as cun, guan and chi.’

Practitioners rely on the quality of the pulse taking into account “frequency, rhythm and volume.”They claim pulse diagnosis reveals “internal and external factors” that cause a disease process while at the same time identifying the affected organ. The tired old canard that western medicine views each organ as functioning individually while eastern medicine “acknowledges” the relationships between all organs is also mentioned.

Pulse diagnosis is associated with belief systems that probably originate during the tumultuous pre-enlightenment period during the Han dynasty (2nd century BC-2nd century AD) when a cultural elite attempted to intuitively categorize elements of disease. The concept of natural correspondence; that is, creating associations with observable natural phenomena gave rise to differing and often competing theories such as philosophies using the five elements or those based on blockages of “Qi” flows:

“A central feature of traditional Chinese medicine (TCM), the Zang-Fu theory represents a fine balanced network which is held between the interior organs of the human body and the conditions represented on the exterior due to imbalances between these organs. There are five Zang organs which include the heart, lung, spleen, liver and kidney…According to Traditional Chinese Medicine (TCM), the inner workings of our bodies, and Zang-Fu organs, are seen as a delicate balance held by the Chinese philosophical concepts of yin and yang - two opposing, yet inseparable forces… Any disturbance of this natural equilibrium results in blockage to the flow of Qi and the onset of disease…With a thorough understanding of the Zang-Fu organs and yin yang balance, a simple pulse diagnosis can reveal more than you think. It is with this ancient diagnostic tool that help traditional Chinese medical practitioners heal from the inside out.”

Another interpretation discusses hard to pin down "pattern associations reminiscent of "intuitive”correspondence. In other words, reflecting the fact that many of the foundational building blocks of interpreting a pulse diagnosis (and acupuncture points for that matter) were created during a historical period of time that, although active and dynamic, never reached an effective consensus of rational theory and reality based medicine:

“The hallmark of TCM as a style of Chinese medicine is its emphasis on treatment based on pattern discrimination (bian zheng lun zhi). This means that, although TCM practitioners first make a disease diagnosis (bian bing), treatment is based more on the pattern discrimination than on that disease diagnosis. In other words, the overall guiding treatment principles for the case at hand are based on the pattern discrimination, not on the disease diagnosis.”

“It is these principles which guide the selection of the Chinese medicinal formula or main acupuncture points. Once these main principles are stated and a basic treatment protocol is erected based on these principles, medicinals or acupuncture points are then added to the base protocol depending on their empirical efficacy for the particular disease under treatment….”

Animals are not immune from this irrational thinking:

"Similarly to human acupuncture veterinary acupuncturists will check the pet’s smell, listen to any noise they make, examine the tongue colour and coating, and check the pulse and specific acupuncture points. A TCM diagnosis helps with point selection but more often that not an intuitive approach, sensing the points and checking pulse changes determines the treatment."

This commentary alludes to the fuzzy logic used in a vain attempt to create associations that categorize and identify diseases. This type of thinking is reminiscent of the empty justifications promulgated for today’s “modern” homeopathic practices. In an era of little pathophysiological knowledge this form of reasoning might be understandable. Today however, there is little basis, other than belief and cultural based rationalizations, to support medical therapies based on this approach.

The intuitive nature of how these medical modalities came about seems obvious. Intuition in and of itself can lead to great discovery. However ideas need to be followed up by corroboration and evaluation before incorporating them into reality based medical practices. In TCM, pulse diagnosis relies on essentially made up assumptions based on shaky conclusions and even shakier understandings of the natural world. This is indeed a weak foundation from where to build elaborate healing practices (including acupuncture).

This is further illustrated by the following statement (Like pulse diagnosis, tongue examination follows a similar strange and irrational logic):

“TCM patterns are discriminated by means of the four examinations (si zhen). These are visual examination (wang zhen), inquiry (wen zhen), listening and smelling examination (wen zhen), and palpation (qie zhen). It is by means of the combination of these four methods of examination (si zhen he can) that a TCM pattern is identified. However, most modern TCM clinical manuals describe this combined summation and analysis in terms of main symptoms (zhu zheng), examination of the tongue (she zhen), and pulse examination (mai zhen). In other words, in clinical practice, patterns are based on three broad groups of information: 1) signs and symptoms, 2) tongue examination, and 3) pulse examination. It is the comparison and corroboration of these three groups of information which differentiate one pattern from another, and it is extremely important that no one sign or symptom means anything except in relationship to all other signs and symptoms gathered by the four examinations.”

As supporters of pulse diagnosis attempt to justify their place as a legitimate practice they resort to familiar fallacious reasoning :

“…we as Western practitioners tend to see a disproportionate number of difficult cases which are either not self-limiting or have not been successfully treated by modern Western medicine and often other types of alternative medicine as well- Ad Hominem, Argument by Seletctive Observation, Ambiguous Assertion. This is because, here in the West, we are so often practitioners of last resort- Ambiguous Assertion, Argumant by Selective Observation, Appeal to Anonimous Authority. Further, because of the modern Western diet, the adverse effects of certain modern Western medical treatments, the ill effects of pollution, and the pervasive stress of our modern society, most of our patients suffer from complex, chronic conditions which frequently and I might even say typically do not display the nice, neat, simple patterns contained in beginners' TCM textbooks.” –Argument By Scenario, Appeal to Compexity, Ambiguous Assertion, Appeal to false Authority, Bad Analogy, Appeal to widespread belief, Fallacy of Compostion, Begging the Question…

Elementary my dear Watson…

Today’s “traditional” clinical diagnostic techniques are built on the foundation of science based knowledge garnered from many disciplines (physics, physiology, biology, chemistry, pharmacology….). Patient diagnostics base themselves on logical threads comprising data collection that include histories, physical examinations, a solid understanding of pathophsiological processes, and the use of evidence based therapies.

The overall goal is concerned with identifying problems, discovering and understanding the disease process behind them, and working towards solutions by applying appropriate management and treatments modalities. Pulse examinations are also utilized- but in a completely different context. They comprise one of a plethora of tools utilized in a physical examination and other situations (pulse monitoring in surgery) that gather bits of information that will be used for problem identification. Unlike the TCM pulse examination, these pulse techniques are based on physiological, anatomical, and biochemical attributes of the body- not energetic or intuitive associations.

Pulse diagnosis as used in Traditional Chinese Medicine (including acupuncture) and other pre-scientific traditions, is an irrational and inconsistent diagnostic methodology and does not meet the standards of repeatability, plausibility, and efficacy for diagnosing anything other than imaginary disease.

Asiancemagazine.com/mar_2007/the_art_of_pulse_diagnosis

www.aworldofacupuncture.com/acupuncture-diagnosis-palpation.htm

www.healthy.net/scr/article.asp?id=1957

www.acupuncture.net.au/clinicalresources/

Schrödinger’s legacy

HΨ = iℏ ∂Ψ/∂t

It is safe to say that nobody understands quantum mechanics. Richard Feynman

It is difficult, maybe impossible to wrap ones head around the strange events occurring at the quantum level; but occur they do. It is a frustrating exercise to imagine any intuitive familiarity regarding the schizophrenic behavior of matter that occurs at these truly tiny dimensions.Trying to relate them to “real world” experience becomes futile. Our sensory “common sense” sensory and cognitive make up simply can not quite put this dualistic reality together, even though, in the same breath, quantum mechanics, a human endeavor, predicts its effects so well.

The quantum wave nature of a human is tiny and undetectable. So much so that it exist within realms where space itself loses meaning and as Al-Khalili (Quantum) states: “we need not be concerned with wavy cows.” An electron traveling at several m/s has a comparatively huge wavelength comparable to the width of a human hair. This is large enough for its quantum wave nature to readily reveal itself even during routine behavior. This is a critical point, a mental "milestone", where many people tend to stumble and confuse what an electron quantum wave can do and think that a human quantum wave can do the same.

The wave function has been described as an abstract mathematical “quantity” that allows for the prediction and calculation of atomic properties. It does not necessarily actually describe the atom itself, or directly imply the atom is the wave function, though whatever is going on, it describes with exquisite accuracy.

Erwin Schrödinger was able to use de Broglies idea of matter waves to explain Bohr’s general model of the atom (electrons move around in atoms in quantized [“fixed”] orbits). He developed an equation that described not the way a particle moves, but how a wave evolves (there are other mathematical methodologies describing quantum system behavior- Schrödinger’s seems the one most taught in basic physics per Al-Khalili in his book Quantum). This formula shed light on the concept of wave functions, their behavior, and revealed the probabilistic nature of quantum mechanics.

The Schrödinger equation is described as an “eigenvalue” equation. That is, it produced what physicists called sensible solutions for specific values of the energy variable of the equation- other solutions produced absurd (i.e. infinity) energy values and were considered nonphysical. In this way, Schrödinger was able to calculate the permitted quantum energy states in hydrogen atoms, and this had broad implications for quantum physics.

Later, Max Born realized the significance and potential of this equation. He found that the Schrödinger wave function itself was an unobservable quantity but that the square of this wave function was observable and, most importantly, probabilistic in nature. These findings had a huge impact on understanding how to predict the quantum behavior of matter. Jim Al-Khalili adds: “In general, a wave function does not simply oscillate like a water wave. It is far more complicated than that…at each point in space the wave function is defined by two numbers known as its real and imaginary parts. Joining all the “real” numbers together produces one wave and the “imaginary” numbers another, and the full wave function is a combination of the two. In addition, a typical wave function will, if plotted on a graph, have a quite complicated shape depending on the system it is describing.”

Today, the wave function is considered by most physicists as being an abstract mathematical “thing” or entity used to extract information about nature, though others consider it some type of actual independent reality. Richard Feynman was able to get correct quantum results using infinite particle paths (sum over histories) instead of wave interactions. Even so, quantum phenomena so closely resembles wave behavior it is most commonly used to describe the “reality” of nature. This however, is not the critical issue as Al-Khalili explains: “Strangely enough, what is important here is that it doesn’t matter whether the wave function is real or not, its mathematical properties are the same; and what it can tell us about the way nature behaves on the subatomic scale is not in any doubt.”

Whether waves or some other concept can describe these strange events Kenneth Ford (The Quantum World) sums up the real issue: “…a quantum entity… is a particle when it is created and annihilated (emitted and absorbed). It is a wave in the interval between those events. Still, adopting this point of view is not sufficient for overcoming the impression of quantum weirdness. You may still want to ask: If the wave starts to propagate outward from the point where the particle is created, how does the wave know where and when to “collapse” to signal the annihilation (the detection) of the particle? The only answer to this question is that the wave is a wave of probability, of potentiality. It gives the likelihood that the particle will end its life at some future time and some other place.”

The link between wave function and probability opened the doors to even stranger findings regarding the nature of quantum phenomena including concepts such as the uncertainty principle, superposition, nonlocality, and entanglement (which will be topics for future posts). As bizarre as these concepts can be, it is important to have some understanding of quantum mechanics and refrain from jumping into non sequitors and false assumptions as physicists expand their knowledge and share their thoughts with us.

Ref:

Al-Khalili, J. Quantum.Weidenfeild & Nicolson. UK. 2004

Ford, K. The Quantum World.Harvard Univ Press.Mass.2005