This review article presents the evidence that the antiinflammatory actions of acupuncture are mediated via the reflexive central inhibition of the innate immune system. Both laboratory and clinical evidence have recently shown the existence of a negative feedback loop between the autonomic nervous system and the innate immunity. There is also experimental evidence that the electrical stimulation of the vagus nerve inhibits macrophage activation and the production of TNF, IL-1β β, IL-6, IL-18, and other proinflammatory cytokines. It is therefore conceivable that along with hypnosis, meditation, prayer, guided imagery, biofeedback, and the placebo effect, the systemic anti-inflammatory actions of traditional and electro-acupuncture are directly or indirectly mediated by the efferent vagus nerve activation and inflammatory macrophage deactivation. In view of this common physiological mediation, assessing the clinical efficacy of a specific acupuncture regimen using conventional double-blind placebo-controlled trials inherently lacks objectivity due to (1) the uncertainty of ancient rules for needle placement, (2) the diffuse noxious inhibitory control triggered by control-needling at irrelevant points, (3) the possibility of a dose-response relationship between stimulation and effects, and (4) the possibility of inadequate blinding using an inert sham procedure. A more objective assessment of its efficacy could perhaps consist of measuring its effects on the surrogate markers of autonomic tone and inflammation. The use of acupuncture as an adjunct therapy to conventional medical treatment for a number of chronic inflammatory and autoimmune diseases seems plausible and should be validated by confirming its cholinergicity. Keywords

In spite of the common belief that Chinese natural philosophy and medicine have a unique frame of reference completely foreign to the West, this article argues that they in fact have significant cognitive and epistemic similarities with certain esoteric health beliefs of pre-Christian Europe. From the standpoint of Cognitive Science, Chinese Medicine appears as a proto-scientific system of health observances and practices based on a symptomological classification of disease using two elementary dynamical-processes pattern categorization schemas: a hierarchical and combinatorial inhibiting–activating model (Yin-Yang), and a non-hierarchical and associative five-parameter semantic network (5-Elements/Agents). The concept-map of the five-parameter model amounts to a pentagram, a commonly found geomantic and spell casting sigil in a number of pre-Christian health and safety beliefs in Europe, to include the Pythagorean cult of Hygieia, and the Old Religion of Northern Europe. This non-hierarchical pattern-recognition archetype/prototype was hypothetically added to the pre-existing hierarchical one to form a hybrid nosology that can accommodate for a change in disease perceptions. The selection of five parameters rather than another number might be due to a numerological association between the integer five, the golden ratio, the geometry of the pentagram and the belief in health and wholeness arising from cosmic or divine harmony. In any case, this body of purely empirical knowledge is nowadays widely flourishing in the US and in Europe as an alternative to Western Medicine and with the claim of being a unique, independent and comprehensive medical system, when in reality it is structurally—and perhaps historically—related to the health and safety beliefs of pre-Christian Europe; and without the prospect for an epistemological rupture, it will remain built upon rudimentary cognitive modalities, ancient metaphysics, and a symptomological view of disease.

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Background Low back pain (LBP) is a prevalent and costly condition that is poorly amenable to medical care. Both patients and clinicians occasionally resort to non‐medical healing such as acupuncture. Objectives The aim of this narrative review is to evaluate acupuncture's claim of efficacy as an adjunct or alternative therapy for the treatment of non‐specific, non‐inflammatory LBP with no neurological symptoms. Methods Evidence was collected from clinical trials, meta‐analyses and systematic reviews conducted in the USA or in Europe. Studies were all published in English, conducted within the last 10 years, and identified exclusively from PubMed, CINAHL and the Cochrane Collaboration. Results Collectively, recent RCTs and systematic reviews provide consistent evidence that acupuncture according to its traditional theories is no more effective for LBP than various forms of non‐invasive controls, including pricking the skin with a toothpick at non‐acupuncture points. This finding not only undermines the traditional tenets of acupuncture, but also discredits its claim of specific effects for LBP. Conclusions If the effects of acupuncture on LBP are mainly due to the treatment ritual or to other psychological factors, then the placebo nature of the treatment must be fully disclosed; otherwise, patients will not be making an informed medical decision. Moreover, the use of acupuncture for LBP might directly conflict with the current positions of the American Medical Association, the American Osteopathic Association, the American Pain Society and the American Society for Pain Management Nursing on the use of placebo for the treatment of pain.