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Original article at http://www.jcimjournal.com/jim/FullText2.aspx?articleID=jintegrmed2013041
Journal of Integrative Medicine: Volume 11, 2013   Issue 4
Dialogue with Dr. Lixing Lao: from a factory electrician to an international scholar of Chinese medicine
Arthur Yin Fan (McLean Center for Complementary and Alternative Medicine, PLC Vienna, VA 22182, USA )

DOI: 10.3736/jintegrmed2013041

Fan AY. Dialogue with Dr. Lixing Lao: from a factory electrician to an international scholar of Chinese medicine. J Integr Med. 2013; 11(4): 278-284.

Received May 12, 2013; accepted June 6, 2013.

Open-access article copyright ? 2013 Arthur Yin Fan.

Correspondence: Arthur Yin Fan, PhD, MD, LAc; Tel: +1-703-499-4428; Fax: +1-703-547-8197; E-mail: ArthurFan@ChineseMedicineDoctor.US

Dr. Lixing Lao, an internationally known scholar of Chinese medicine renowned for his clinical and mechanisms research, is the Director of the Traditional Chinese Medicine (TCM) Program at the Center for Integrative Medicine, University of Maryland (UM) School of Medicine; the Co-Chair of the Acupuncture Research Society; and the former Editor-in-Chief of the American Acupuncturist, the official journal of the American Association of Acupuncture and Oriental Medicine. The Baltimore Magazine has listed Dr. Lao as one of the nation’s top acupuncture practitioners (Figure 1).
Dr. Lao has played a pivotal role in the advancement of TCM in the United States. As the first full professor of acupuncture and TCM appointed to a conventional medical school in the United States, he was invited to be a key speaker at both the 1994 United States Food and Drug Administration (FDA) hearing on acupuncture[1,2] and the 1997 National Institutes of Health (NIH) consensus conference on acupuncture[2]. As a result of the hearing, the FDA reclassified acupuncture needles as a medical device, no longer an investigational device. The NIH conference led to preliminary confirmation of the safety and efficacy of acupuncture. These two conferences were milestones that opened the way to wider clinical use of acupuncture.
Besides research and clinical practice, Dr. Lao has been involved in TCM education for over 20 years. On October 20, 2012, the author, Arthur Yin Fan, interviewed him in the President’s Office of the Virginia University of Oriental Medicine in Annandale, Virginia, USA.
Fan: Dr. Lao, it is nice to see you again. What have you been doing recently?
Lao: As a professor in UM’s Center of Integrative Medicine, I’ve mainly been doing research, and conducting clinical trials and experiments on the safety and efficacy of acupuncture and herbs. As an academic, I’m also involved in teaching.
Fan: I heard you’ve attended some conferences recently.
Lao: Yes, I have participated in quite a number of conferences, domestically and internationally. In November, I will go to Beijing, China, for the anniversary celebration of the Beijing University of Chinese Medicine, which will be combined with an international acupuncture conference. I’ll be one of the main speakers.
Fan: You have been involved in TCM for over thirty years. Now you are an international, leading scholar in this field. What led you to this profession?
Lao: It’s a long story. During the Chinese Cultural Revolution in the late 1960s, formal education stopped. All students became involved in what was called “Stopping Class to Conduct the Revolution” [停课闹革命; Dr. Fan notes: This was similar to school strikes and student occupations in the West, from December 1966 to October 1967]. At that time, “barefoot doctors”— practitioners using acupuncture, herbal medicine, and basic medical procedures like first aid — began to treat the poor rural farmers [Fan notes: more than 90% of the Chinese population lived in impoverished rural areas and lacked basic health care before the barefoot doctors movement]. Such a career was attractive to many young people, including me. There was no strict regulation of acupuncture during the Chinese Cultural Revolution (Fan notes: because the traditional or “old” regulations were dismantled by Chairman Mao Zedong, who was a supporter of barefoot doctors). Many young adults learned TCM in various ways and became barefoot doctors during that period. There was no formal schooling during the Cultural Revolution, and I long to learn something real and useful. I became interested in acupuncture because I had heard many moving stories about the barefoot doctors, which triggered my interest in medicine and health care.
Another reason for me to learn acupuncture or TCM was because of an incident in 1970 during the so-called “Returning to School to Make Revolution (复课闹革命, Fan notes: after October, 1967)”. It was what would have been my last year of high school; students were assigned to factories for half a year and rural areas for the other half to get “real knowledge.” First I was sent to learn farming on Chongming Island, a county of Shanghai City, in the middle of the Yangzi River. One night I began experiencing severe acute abdominal pain, which was later diagnosed as an intestinal obstruction. It was the middle of the night. With great difficulty and the help of my classmates, I walked for miles to see a doctor, Madam Lin, a very nice, extremely proficient old lady who was the doctor assigned to provide medical care for the students from my high school on the island. At that time there was no highway to Shanghai, and the Shanghai ferry ran only during the day. So there was no choice — I could not go to Shanghai despite the emergency. Acupuncture was the only treatment available. It was really magical: Dr. Lin needled me in two places. The pain quickly disappeared and then I slept. I woke up the next morning with no pain. After asking me several questions, Dr. Lin felt there was no need to send me to the hospital in Shanghai and let me go back with the other students. That experience affected me greatly.
Later, during a down period when there was not much to do on the farm, Dr. Lin arranged a class for students. She taught us basic medical knowledge, including the prevention of illness and some basic treatments. I wanted to see how she treated patients and handled difficult cases, so I carried her medical kit when she made home visits. In effect, I was her apprentice, although it was not a formal apprenticeship.
The second half of that year was spent in a factory in the city of Shanghai. There was an elective project —learning medical knowledge. As high school students we had a chance to participate in a three-month training program for suburban barefoot doctors at a district hospital, but only two students per class could be enrolled. I was the class president and had a strong interest in medicine, so I got the chance to attend, and I learned a lot. At that time we were 16 or 17 years old and eager to learn. The school no longer taught normal classes, and the students wanted something to fill their empty brains. The program started with two weeks of classroom teaching; teachers (they were medical doctors) with different specialties taught acupuncture and Western medicine as well as topics such as rescue methods to be used after atomic bomb explosions, how to hold a scalpel when performing an operation, how to interpret an electrocardiogram, and so forth. I remember that when the doctor taught acupuncture, he taught us 30 acupoints a day, including point location, main effects, and insertion techniques for each point. The next day, we would have to stand up to answer questions. We two high school students were always very participatory and liked to answer the questions, while the barefoot doctor candidates, mostly young suburban mothers, were afraid to answer. They were so busy with field and house work after class and they had little time to go over the lessons. That class gave me great pleasure.
After the classroom learning, we interned in each department, starting with the pharmacy. Under supervision, we prepared Western drugs and patent herbs according to the prescriptions that patients brought in. After three days, we were familiar with the names of many drugs and patent herbs and their actions. Then we went to the department of internal medicine. The first few days we copied the doctor’s prescriptions and observed the physical examinations. After that, we could see patients and prescribe medicine under the doctor’s supervision. I started seeing patients on the second day because my supervising doctor considered me ready to practice. We were in a district hospital, patients often came from local factories and the illnesses and disorders were simple. Mostly, I took a patient’s blood pressure, asked some questions, and then refilled a previous prescription; or something like low back pain and patients just wanted pain killers or an excuse for sick leave; rather simple stuff; that was it. My classmate and I sat at two office tables all morning and counted up our patients, competing as to who had seen the most — that was fun and got me interested in medicine.
After that department, we interned in injection room and then in the acupuncture and moxibustion department. There was a doctor, half blind, a graduate of the Tuina (Chinese therapeutic massage) Program from the Shanghai College of TCM. Maybe because of his poor vision, his memory was very strong; he could recall all the acupuncture points and tuina manipulations. At that time, he was single and lived in the hospital dorm near my home. So every night I went to his dorm and learned from him. He talked about the acupuncture and tuina he had learned in college, and I took notes. I became very interested in acupuncture at that time, and it was something like a real apprenticeship. We became good friends.
In 1971, the “old-three grades (老三届) settling in the countryside and mountains” movement (上山下乡; launched by the government) stopped, and middle and high school students and graduates again had a chance to stay in the city. One reason I’d learned acupuncture and moxibustion was to give me a way to take care of myself if I had to live in the countryside. I wanted to be prepared to serve rural patients and my fellow schoolmates who might be resettled there. But when I graduated from high school, I was assigned to the Shanghai Xingzhong Power Machinery Factory (新中动力机器厂) as a factory worker. After training in several jobs, I became an electrician, maintaining the normal operation of the electronic devices there. If there were problems with a device, I would have to work very hard to fix it as quickly as possible in order to avoid a delay of production; otherwise, I’d wait in the office without much to do.
My Shifu (teacher and supervisor) graduated from Shanghai Jiao Tong University. He preferred being an electrician to being a technician, and he taught me a lot. He was a nice man, and to this day we remain friends. My Shifu not only taught me practical skill of repairing electronic devices but also taught me theory of electricity, so I learned faster because I understood the mechanisms. One night, he invited me and his good friend and former classmate, to dinner at his home. His friend arrived with acute low back pain, which began during his bus trip over to dinner. He said to me, “I heard you know acupuncture. Please give me a treatment; I am very hurt.” At that time, I carried acupuncture needles around with me in a pen-like tube. There were no regulations for doing acupuncture at that time, so I gave him a treatment and after removing the needles asked him to move his back as much as possible. To his surprise, his pain was gone; the back muscle spasms disappeared immediately after the treatment. The result pleased him and my Shifu, so by word of mouth, many people found out that I was good at acupuncture.
A few days later, a very old employee in the finance department of the factory came to see me. He had bad intercostal neuralgia. He said he had had three onsets: the first had been cured by a famous TCM doctor, Shi Xiaoshan (石筱山); the second was cured by another famous doctor — I forget the name. Now it was the third onset; he said he’d already seen many doctors and tried many medications, both Chinese and Western, and nothing helped. So he used a lot of pain-killers that only masked the pain for two to three hours, and also upset his stomach. He wanted me to give him acupuncture. I told him I had not treated anyone with such a condition but I would try. His pain was active, so I treated him. He got immediate results and was very pleased. After that, I became very busy — before, people called me only for something electrical, and now people began to call me for their health issues too, especially low back pain and sciatic pain. I had to keep two sets of equipment — my electrician’s tools plus the acupuncture needles and some alcohol swabs for disinfection. I enjoyed helping people for their illness and treated them for free, as a colleague.
Fan: How old were you at that time and when you started your college study?
Lao: I started at that factory when I was 17, and stayed about 7 years. The college entrance examination (CEE) started up again in 1977 after the Culture Revolution stopped in 1976. So I was 24 when I entered college in the fall of 1978. During the Cultural Revolution, I had had formal education only up to actual fifth grade level (although I was a high school graduate) because the classes were disbanded to “make revolution.” I did not think I had enough knowledge to pass the CEE, but my high school math teacher encouraged me to try. I then borrowed middle and high school textbooks and started self-study with some help from my math teacher and my Shifu. I was lucky enough to pass the exam in July 1978 after about 5 months of extensive study.
Fan: How was your experience in college?
Lao: I was accepted and admitted to the Shanghai College of TCM and assigned to the acupuncture major. I initially thought I already knew enough acupuncture and wanted to the major in Chinese herbal medicine. But soon after I started the course work, I found I actually knew very little about acupuncture. The clinical experience I had earlier helped me to better understand TCM and acupuncture theory as well as other courses, including Western medicine. I studied hard and enjoyed the five-year learning opportunity and did not want to waste time that had been lost during the Cultural Revolution. I was elected president of our class and vice president of the Student Union of the college.
Fan: Very impressive experience. Then you enrolled in the University of Maryland for PhD study in physiology and also got your acupuncture license in the State of Maryland?
Lao: After graduating in 1983, I was appointed to the Acupuncture Department of my college as a teacher and researcher. Then China encouraged young people to go abroad for study, which was one of the important policies of the reform. I applied to the Physiology Department of the Dental School at UM because it has a pain research group as I was interested in the mechanisms of acupuncture for pain relief. At that time, the National Certification Commission of Acupuncture and Oriental Medicine (NCCAOM) initiated an acupuncture certificate examination oriented mostly toward TCM. Because of my teaching background, I was invited to review point locations for a group of a local acupuncture school students who were preparing for that examination. Local acupuncturists also told me I was eligible to apply for an acupuncture license in the State of Maryland. So in 1988 I became licensed as No. 300, the 200th licensed acupuncturist in Maryland (the license number starts at No. 101). Later I also passed the exams and obtained NCCAOM certification of acupuncture and Chinese herbal medicine.
Fan: At that time, acupuncturists worked under the supervision of an MD. How did you start your clinic?
Lao: I had to work under an MD’s supervision. A local acupuncturist referred me to Dr. Sores, a very nice Filipino-American doctor. She told me that she had just visited China with a group of American physicians and was deeply impressed by the acupuncture anesthesia she’d observed. One MD could supervise three acupuncturists at that time; I became her second one. Dr. Sores was so kind to let me use her clinic, which was near the Johns Hopkins University, when there were rooms available. She waived the rent for the first several months; even later, she charged a fairly low rent. I studied for my Ph.D. during the day and worked in the clinic from 6:00 to 9:00 pm two or three days a week until graduation.
Fan: How did you get your academic appointment at the University of Maryland School of Medicine?
Lao: A year before my graduation, I had a period of deep confusion. If I took a postdoc position in a laboratory for physiological research, I’d have to move (to other states) and leave my flourishing acupuncture practice; if I stayed in my Maryland practice, I’d have to leave my academic career. I’d studied acupuncture for five years and spent five more on my PhD in physiology. Giving up either would be a pity. By luck, in 1991 I saw an announcement in the school magazine and the Baltimore Sun saying that an MD, Brian Berman, had been awarded a million dollars to set up a complementary medicine program to study the safety and efficacy of acupuncture, Chinese and other traditional medicine, and alternative medicine in the Department of Anesthesia, UM School of Medicine. After I talked to him about possibility to work with him, he offered me a research assistant professor position and wanted me to start work at once. I still hadn’t completed my dissertation and actually couldn’t. But we became friends. In one occasion, I successfully treated his two-year-old daughter with tuina and became his family acupuncturist. On June 15, 1992, the day after my dissertation defense, I started work as an assistant professor in his program.
It was the right time, right place, and right people. In 1992, the NIH established the Office of Alternative Medicine (OAM). Dr. Berman was on their advisory board and took me to many meetings. In 1993, the OAM formally started to award fairly small, $30 000 research grants to about thirty awardees. We applied and were awarded two grants in 1994. I was the principal investigator (PI) of one project named “Acupuncture and Postoperative Oral Surgery Pain”; Dr. Berman was the PI and I was the co-investigator of the second program “Acupuncture Safety/efficacy in Knee Osteoarthritis”. After this seed funding, we got bigger grants, NIH Research Project Grants, also known as R01 grants, to continue both these projects. The clinical trial of acupuncture on knee osteoarthritis (OA) had a great impact. This large sample (N=570) trial found that acupuncture was significantly more beneficial for patients with knee OA than those in sham control[3]. We continued such work on arthritic pain and now are involved in other modalities such as Chinese herbal medicine, laser acupuncture, and moxibustion.
In 1998, we got a Center Grant known as P50 from the National Center for Complementary and Alternative Medicine (NCCAM, former OAM), which consists of funding for three projects focused on a research question; I served as the Project Leader on mechanisms of acupuncture in inflammatory pain and established our first laboratory for the basic science research on acupuncture and TCM. Since the establishment of the lab, we have published many basic science studies on acupuncture and herbology. You were there three years, Arthur. Thank you for your great contribution to our lab’s research on the mechanisms of Chinese herbal medicine. Because of our significant achievements from earlier, we’ve gotten several big grants (known as P50, P01 and U19) over the last ten years and also many smaller ones.
Fan: Your clinical trials, especially on acupuncture for knee OA[3] and on nausea and vomiting caused by chemotherapy, made great contributions toward persuading commercial healthcare insurance companies to cover the use of acupuncture for such illnesses. Since then, more and more insurance companies have begun to pay for acupuncture treatments.
Lao: You’re right. I feel we have done the right thing — choosing to study illnesses commonly seen in clinic and publishing our results in major medical journals. Positive results give practitioners great support.
Some acupuncturists and research colleagues didn’t understand why we chose to study arthritis. They told us, “We use acupuncture to treat arthritis every day. It’s been done for thousands of years, especially in China, and with good results. Unquestionably, acupuncture can treat arthritis. Why waste time doing a clinical trial on that?” The fact is, although there is a consensus among acupuncturists and Oriental medicine professionals and some patients, many Western-trained doctors and their patients have no understanding of the safety and efficacy of acupuncture. We need to demonstrate the effect and safety of acupuncture in treating common illnesses for which medications aren’t too effective. In America there is a high incidence of arthritis, which doesn’t respond well to conventional medication. Most arthritis, especially knee OA, is chronic. Pain medications are only briefly effective, and must be used long term, which lead to serious adverse effects. And the safety and effectiveness of acupuncture on OA is easy to evaluate. In an illness such as diabetes, which has many complications, treatment results may be hard to measure.
Our strategy was to study the condition most suitable to acupuncture treatment first. Positive results would help the mainstream medical profession to start accepting acupuncture, and then we can tackle more difficult diseases. If we had chosen a difficult one first and not gotten a positive result, people might believe that acupuncture is simply ineffective, not that we got a poor result because we didn’t choose a suitable subject. So we picked something less complex first. Also, we wanted to pick a common disease, and there are many OA patients.
I researched textbooks, clinical trials, and case reports to decide which acupoints and acupuncture strategies we should use, and then tested these in a small group of patients to ensure they’d be effective in clinical conditions. Additionally, as you know, success depends on the “right time, right place, and right people”. There was a strong need to show whether acupuncture is safe and effective, and we had a good team. Besides Dr. Berman, me, and our TCM research personnel, we invited Dr. Marc C. Hochberg, a doctor in our school of medicine at UM and an internationally known knee expert, to provide a set of evaluation and assessment methods for knee OA. His support was essential to the project’s success.
Acupuncture and Chinese medicine professionals might also feel that a study on acupuncture for dental extractions[4] is unnecessary since doctors and researchers in China have done acupuncture anesthesia studies showing that acupuncture is an effective anesthetic in major operations. Dental pain is a very small topic. But when I designed the dental project, I wanted to refute the preconceptions of the conventional medicine practitioners and some others who believe that acupuncture is a placebo, i.e., that its apparent effectiveness is only a result of psychological expectation.
In designing that study, I found that there were advantages to doing acupuncture immediately after an extraction. The novel control was established; patients couldn’t easily differentiate between real, needle insertion, and sham, no insertion, acupuncture — right after extraction, the local anesthesia hadn’t worn off and patients were blindfolded, so when acupuncture was performed on Jiache (ST6), Xiaguan (ST7), Yifeng (SJ17) and Hegu (LI4), the patient didn’t see or feel the procedure. Establishing an effective control is a difficult thing in acupuncture studies; sham acupuncture isn’t like a pill that can be the same shape and size as a drug being tested. Although we could have used shallow needle insertion at the real point, these can induce physiological reactions. The best control is non-insertion. Patients might be able to distinguish between insertion and no insertion, but it was not in this project when our subjects were still under local anesthetic.
I modified the model a little for our clinical trial. In the original model, the researchers administered medication about an hour after tooth extraction, when moderate pain starts. I decided to use acupuncture as prevention, with pain-free time being the main indicator, and pain level as the secondary indicator. Before the trial, I did a preliminary study using several patients undergoing tooth extraction. Most actually had no pain after the acupuncture and didn’t need pain medication. My second modification was patient blinding — patients were literally blindfolded during the acupuncture. The test period was only 6 h, very short. A long period might cause a patient to realize if he had received real acupuncture.
The reason I chose postoperative dental pain was because I graduated from the dental school’s PhD program and knew the dental doctors there. I contacted Dr. Bergman, who is an oral surgeon who is interested in acupuncture. We did a few patients to obtain preliminary study data and observed that acupuncture was very good for dental pain after tooth extraction. Then we started a formal collaboration and applied for a research grant from the NIH. Our study showed acupuncture to be much better than sham — or placebo — acupuncture. That study might not have much clinical significance, but it is scientifically significant. It addresses a few questions, such as whether acupuncture is a placebo.
Fan: Those clinical trials that show acupuncture to be no better than placebo — there have been many, such as that of the trial published by a Seattle Group[5]; the results were all similar — I consider the problem to be one of design. First of all, is so-called sham acupuncture really sham? And are its results really placebo effects? Needle insertion effects are not like effects of oral or i.v. medication. Applying a medication model and trial design in an acupuncture study might not produce good research. Also, acupuncture’s time-point effectiveness varies; some effects show up immediately; others require a 10- or 16-session course or six months. Giving 10 sessions of so-called sham and expecting patients not to know if she/he is getting real acupuncture is difficult if not impossible. As you say, if you expect to blind patients but use strong “sham” stimulation, that could induce physiological reactions and amount to actual acupuncture. Also, if the statistical design is wrong, differences won’t show up; this can happen especially if a sample is too small.
Lao: True. I’ll give you an example with a sound methodology, because study methodology is improving so we can have more confidence in the results. A group of researchers in New York led by Vickers did a well-known literature review published in the Archives of Internal Medicine in 2012[6]. Archives of Internal Medicine is one of the archives of the Journal of American Medical Association (JAMA), which is a very prominent journal, and this review was widely reported by the media. Vickers got NIH funding five years ago. He asked researchers who published papers on large acupuncture clinical trials to give him the raw data from their studies. Using those data, Vickers’ team repeated the original statistical analyses to see if they could get the results that were originally published. Twenty-nine high quality acupuncture trials were analyzed, which involved four types of chronic pain lasting more than four weeks: knee OA inflammatory pain; musculoskeletal pain — low back and neck pain; headache — migraine and tension; and shoulder pain. The 29 studies used yielded a total of 18 000 chronic patients divided into at least three groups: acupuncture, sham acupuncture, and routine conventional medicine. The results showed that acupuncture performed much better than the routine conventional treatments and better than sham. The most interesting thing from this paper was that Vickers predicted that if this study were repeated after a few years, the chance of overturning these conclusions would be very low or almost impossible because, statistically, it would take 47 trials of more than 100 patients each, with an effective size of 0.25 in favor of sham controls, to obtain negative results. This study is convincing because it accounted for all possibilities.
Fan: We are both clinical practitioners. So you might agree with my feeling — that the so-called sham acupuncture used in so many clinical trials[5,6]actually is a variation on real acupuncture. Each school of acupuncture has a different style; some use gentle or shallow stimulation in which the patient might not feel the needling sensation at all; some use extra-meridian acupoints. I myself, in different patients and even in the same patient according to different circumstances, conditions, or body parts, might use different stimulation strategies. So it seems to me that gentle or shallow insertion, non-insertion, or extra-meridian insertion isn’t necessarily sham acupuncture. If using a toothpick to mimic acupuncture is sham, then how do we explain the action of the Bian Shi (stone needle), an alternative to the filiform needle? I feel that if metal needles or toothpicks induce a physiological reaction, that’s real acupuncture. In a drug trial the researcher can use an inert pill.
Lao: You are correct. These factors make it more difficult to design an adequate acupuncture sham control. Since the mechanism of acupuncture effectiveness itself is not clear, one can’t design a control that has no such mechanism (like an inert placebo pill). For a conventional medication, its mechanism is relatively clear, such as it works on certain receptors or certain pathways, so it is easy to design a control that does not have that function on these targeted receptors and pathways.
Fan: Why do we still use sham acupuncture in clinical trials?
Lao: The concept of sham control is not bad. The problem is we just don’t know what would be an appropriate “sham”. Some people in the mainstream medical field who have the “speaking rights,” insist on adding so-called sham controls. Although this is not good practice, we have no choice. We have to conform to the status quo. However, in recent years, patient-centered, comparative effectiveness research that more accurately reflects daily acupuncture practice, not using a sham control, has been drawing the attention of many researchers. I believe that type of research will be the next step of acupuncture research – to determine which conditions are most suitable for acupuncture treatment, as compared to conventional treatment.
Fan: What are your comments on the acupuncture research going on in China?
Lao: TCM’s birthplace is China, although none of the papers we’ve discussed were published by scholars in China. I hope that one day soon scholars there will be performing high-quality research. This is why I am so eager to help young scholars in China with study design. As the Chinese economy improves, the Chinese people should take more responsibility for TCM research and produce studies that can’t be dismissed because of poor quality. I want to foster the development of acupuncture and TCM because they really do help patients, are easy to use, and are cost effective. I would like to see researchers in China to conduct more serious and vigorous high-quality studies.
Fan: I admire you. You have been an acupuncture and Chinese herbal medicine researcher for over 20 years and are regarded internationally as a spokesman of TCM research. You’ve met so many difficulties and still have remained mentally strong. What gives you the strength to do so well?
Lao: I am very confident about the development of acupuncture as well as TCM as a whole. Success is based on small daily accumulations. The current situation of acupuncture and herbology is much better than it was a few years ago. Although our profession still has some problems, we should stay optimistic. I believe the proverb: real gold doesn’t fear the fire that smelts it.
Fan: I hope you continue to make contributions, in acupuncture research, in education, and in legislative and political activities.
Lao: Thanks for your interview.
Fan notes: Between June, 1992 (one year after the Center was established) and the present, the center where Dr. Lao works has received more than?35?million dollars in funding from the NIH and other different sources, for carrying out research on acupuncture and Chinese medicine. As a principal investigator or co-investigator, Dr. Lao has been on 28 grants or research projects. Dr. Lao so far has published 142 peer-reviewed papers, 26 non-peer reviewed, invited papers, and 10 book chapters. He is a co-editor of a new acupuncture and moxibustion textbook that will be published by the end of this year. He was the chair of the 2007 Society for Acupuncture annual meeting – “The Status and Future of Acupuncture Research: 10 Years Post-NIH Consensus Conference”, and also chaired the 2010 WFAS (World Federation of Acupuncture and Moxibustion Societies) annual conference in San Francisco, CA.
AcknowledgementsThe author would like to thank Ms. Lyn Lowry for English editing. The interviewer was Dr. Arthur Yin Fan.
Competing interestsDr. Arthur Fan worked in Dr. Lixing Lao’s laboratory and participated in acupuncture and Chinese herbal mechanism studies from 2002 to 2005 as an NIH Fellow in Chinese medicine. The author declares that he has no competing interests.

Figures and Tables in this article: 



Figure 1  Dr Lixing Lao at Virginia University of Oriental Medicine This picture was taken by Byung Kim.

References

1. Fan AY, Fan Z. Dr. Wu: a beautiful, moving and meditative song — in memory of Dr. Jing Nuan Wu, a pioneer of acupuncture and a Chinese medicine doctor in the United States[J] J Chin Integr Med, 2012, 10(8) : 837-840.
2. Fan AY, Fan Z. The beginning of acupuncture in Washington, D.C. and Maryland: an interview with Dr. Yeh-chong Chan[J] J Integr Med, 2013, 11(3) : 220-228.
3. Berman BM, Lao L, Langenberg P, Lee WL, Gilpin AM, Hochberg MC. Effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the knee: a randomized, controlled trial[J]. Ann Intern Med, 2004, 141(12) : 901-910.
4. Lao L, Bergman S, Langenberg P, Wong RH, Berman B. Efficacy of Chinese acupuncture on postoperative oral surgery pain[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 1995, 79(4) : 423-428.
5. Cherkin DC, Sherman KJ, Avins AL, Erro JH, Ichikawa L, Barlow WE, Delaney K, Hawkes R, Hamilton L, Pressman A, Khalsa PS, Deyo RA. A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain[J]. Arch Intern Med, 2009, 169(9) : 858-866.
6. Vickers AJ, Cronin AM, Maschino AC, Lewith G, MacPherson H, Foster NE, Sherman KJ, Witt CM, Linde K; Acupuncture Trialists’ Collaboration. Acupuncture for chronic pain: individual patient data meta-analysis[J]. Arch Intern Med, 2012, 172(19) : 1444-1453.
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There are six papers in http://www.PubMed.gov, a NIH database for Modified Huo Luo Xiao Ling Dan, Dr.Arthur Yin Fan involved in most of these studies, included in pre-clinical studies for safety evaluation and efficacy tests, mechanism explorations. This project was a NIH funded studies conducted in University of Maryland Harvard University.

Lao L, Fan AY, Zhang RX, Zhou A, Ma ZZ, Lee DY, Ren K, Berman B.

Am J Chin Med. 2006;34(5):833-44.

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作者:劳力行, 布赖恩·伯曼    作者单位:马里兰大学医学院结合医学中心, 美国马里兰州 巴尔的摩

【摘要】 马里兰大学医学院的补充医学中心成立于1991年,是美国在西医学院成立的第一个以研究中医药为主的综合性补充和替代医学中心。从1995年起连续被美国国家健康研究院评为全国中医研究的杰出中心,研究主要集中在评估中医药、针灸和身心疗法如气功、冥想/入静疗法的安全性、有效性及作用机制。补充医学中心作为马里兰大学的交叉学科中心,主要承担了科研、临床、文献和教育4个方面的工作,彼此促进,已形成一个充满凝聚力的团队。中心近年来还增加了针灸和中医药研究在国际间的交流合作,特别与中国的香港中文大学、上海中医药大学和其他中医药大学进行了合作。

【关键词】 结合医学; 补充医学; 替代医学; 美国

马里兰大学医学院位于美国东海岸的马里兰州巴尔的摩市,离美国首都华盛頓仅30多英里。它成立于1807年,距今刚过200年的历史,是美国最早的公立医学院。马里兰大学医学院的补充医学中心成立于1991年,后改名为结合医学中心(Center for Integrative Medicine, CIM),是美国在西医学院成立的第一个以研究中医药为主的综合性补充和替代医学中心。巧合的是,同年美国国会批准拨款,在美国国家卫生研究院(National Institutes of Health, NIH)成立了替代医学办公室(Office of Alternative Medicine),后升格为国家补充和替代医学中心(National Center for Complementary and Alternative Medicine, NCCAM)。由此,研究和应用包括针灸、中医中药在内的补充和替代医学热潮自美国乃至整个西方掀起,至今不衰。马里兰大学结合医学中心积极参与了此过程。中心的创始人Berman博士曾是第一届NCCAM的顾问委员会(Advisory Board)委员之一,他与在1992年加入该中心的Lixing Lao(劳力行)博士都参与筹备了1994年美国食品药品管理局(Food and Drug Administration, FDA)的针灸研讨会(NIH-FDA Workshop)和1997年NIH的针灸听证会(NIH Consensus Conference on Acupuncture),并都在大会作了报告。FDA-NIH的针灸研讨会最终使FDA正式把针灸定性为医疗器械(Class Ⅱ)[1-3]。而NIH的针灸听证会更是从最高的学术层面肯定了针灸的医学地位和科学地位[4]。马里兰大学巴尔的摩分校的校长(President of the University of Maryland Baltimore)Ramsey博士被NIH特邀为该NIH听证会的主席主持了大会。

中心自成立以来,在该中心主任Berman博士主持下,一直致力于评价补充和替代医学,并将其整合到主流医疗保健体系。中心现有研究人员35人,主要进行科研、临床、文献和教育4个方面的工作,其中中医药和针灸的临床和科研部分由生理学博士暨中医针灸执照医生Lixing Lao教授主持。

1  科学研究

中心自1991年成立的17年来,一直成功申请到NIH的科研资金。更从1995年起连续13年被美国NIH评为全国中医(traditional Chinese medicine, TCM)研究的杰出中心,至今已受到NIH超过3 000万美元的科研经费资助,发表的相关研究有300多篇属于科学引文索引(Science Citation Index, SCI)论文。中心开发了一系列有效的临床及实验室研究方案,对传统与替代医学研究的安全性及有效性进行研究。中心的研究主要集中在中医药或针灸的有效性、安全性以及作用机制方面,特别在中医针灸临床试验方法学上做出了独特贡献,其特点是在运用严谨的科学方法的同时不失中医针灸的传统特色,并在研究中遵循循序渐进的原则。在疾病方面,该中心主要针对急、慢性疼痛如关节炎炎性疼痛、手术后疼痛、癌症疼痛以及癌症化疗引发的疼痛和恶心呕吐等病症,最近又对针灸治疗不孕症和气功治疗毒瘾进行了研究。中心开展了一系列临床试验、临床前期基础试验和调查研究以评价补充医学疗法的安全性和有效性,并进行成本-效益分析,同时也对将这些补充医学疗法整合到主流医疗保健体系的可行性进行评价。

从基础研究到临床试验,该中心的研究项目主要包括以下3个方面:(1)关于中医药和针灸作用机制的基础科学研究;(2)关于中医药和针灸及其他补充医学疗法的安全性、有效性及其成本-效益分析的随机对照临床试验和疗效评价研究;(3)对已有的补充与替代医学疗法的研究资料进行循证医学的系统评价,给临床医生及使用者在不同疾病情况下应用不同疗法提供有说服力的证据,并为将来的研究设计提供信息。由于中医药研究人员齐备、资源充足及中医药的临床优势等有利条件,中心的研究重点还是在中医药和针灸的研究。

1.1  中医药与针灸临床研究项目  中心的临床研究着重于:(1)探索中医药研究的方法学;(2)针对西医颇感棘手和治疗有副作用的病症进行补充治疗;(3)提高慢性病患者的生活质量。早期的课题包括针刺治疗口腔外科手术后疼痛[5,6],电针治疗化疗致恶心呕吐[7],针刺治疗膝关节炎[8-10],中医师对类风湿性关节炎中医诊断和中药处方的一致性[11,12],针刺治疗不孕症疗效评估等[13]。

目前正在进行的研究还有中药治疗骨关节炎的有效性与安全性,中药治疗肠功能紊乱的有效性与安全性,针刺与冥想治疗抑郁症,针刺对创伤后昏迷和手术后疼痛的急救治疗,气功治疗膝骨关节炎,气功治疗可卡因依赖等研究课题。

这些研究中至今比较有影响的工作有针刺对拔牙痛的效应[6]以及针刺治疗膝骨关节炎[9]的临床试验。其中对牙痛的相关研究成果发表在Archives of Otolaryngology: Head and Neck Surgery等主流医学杂志上,该试验首次应用了系统性非刺入性的假针灸方法,改变了以往认为针刺研究不能实现盲法的观点,使假针对照变为可能,结果显示针刺作用优于安慰剂效应,从而证实了针刺治疗并不仅仅限于安慰剂效应[6]。2004年该中心又发表了针刺治疗膝骨关节炎的大型Ⅲ期多中心临床试验[9]。该试验应用了假针对照(sham control),采用进针与非进针相结合的假对照方法,成功实现了盲法以及隐蔽,结果显示针刺的疗效在缓解疼痛及改善功能方面均明显优于假针安慰对照。该研究是《内科医学年鉴》杂志的主角文章,并在出版后的第一个月就吸引了世界上包括中国在内的230多万次媒体报道。该中心目前已取得NIH的一项为期5年的资助,继续研究中药方剂对膝骨关节炎的疗效和安全性。中心与NCCAM和美国FDA有着长期良好的工作关系,已经申请到该项中药的临床试验许可证(investigational new drug, IND)。

1.2  中医药与针灸的前期基础研究  中医与针灸的前期基础研究也有多项突破。其中的研究项目包括电针治疗慢性炎症疼痛的机制[14-17],电针对外周阿片物质释放的影响[18],电针对化疗致恶心呕吐的影响[19],中药治疗慢性炎症与疼痛的机制[20],以及中药对自身免疫性关节炎的调理作用等课题。

最近,Ruixin Zhang博士负责的中心基础实验室又进行了癌症疼痛及化疗引起的神经性疼痛的相关研究,并从NIH获得两项课题研究资助,旨在研究针刺对其止痛的机制。目前已完成一系列临床观察和实验,建立了大鼠骨癌痛模型[21],评价了针刺对大鼠骨癌疼痛的疗效,并在此基础上进行了骨癌痛的机制研究和针灸镇痛的相关研究,成果已在Pain等具有国际影响的杂志上发表[22-24]。

另外,中心还和Cochrane合作协调全世界范围内的中医药和补充替代医学领域的活动。中心还在NIH的资助下建立了一个国际中医药研究中心,与香港中文大学进行合作,主要是研究中医药治疗肠功能紊乱。目前正在进行的研究包括电针对内脏疼痛模型的影响和机制,中药处方治疗肠功能紊乱的安全性、机制与生物反应,以及中药治疗肠激惹症的临床双盲对照试验。近年来中心还与中国的上海中医药大学、北京中医药大学和韩国成熙大学及韩国东方医学研究中心(Korea Institute of Oriental Medicine)等进行了合作,共同发表了文章[2529]。

2007年秋,在巴尔的摩市马里兰大学医学院举办了一次由美国针灸研究学会(Society of Acupuncture Research, SAR)主办,马里兰大学医学院结合医学中心承办的大型国际会议,Lixing Lao教授作为SAR的共同主席之一组织了本次会议。来自20个国家的近400位代表出席了本次会议,包括中国中医研究院的高层领导在内的10余位中国代表也参加了会议。会议主题是回顾自1997年NIH听证会召开后的10年间的针灸研究进展。会议期间,来自世界各地的针灸研究者介绍了包括针灸临床以及实验研究在内的最新成果。这次会议的成功召开显示了马里兰大学医学院结合医学中心在针灸现代研究中的领先地位[30,31]。

2  临床治疗

在马里兰大学结合医学中心所属诊疗中心的门诊,整个团队包括训练有素的补充医学方面的医生和专业人员,以期从常规现代医学和补充医学的结合中找到最佳方案,用于病人的治疗与保健。诊疗中心为病人提供一系列诊断和治疗选择。医生拥有多项执业资格,对整合各种疗法训练有素。门诊还提供初级医疗保健服务,并可根据病人的特别需要度身制订健康计划。除常规现代医学治疗以外,中心还提供传统中医、顺势疗法、针灸、营养、放松疗法、健身和草药等其他疗法。

中心的医生和操作师均具有丰富的临床实践经验和知识,能够为每位病人提供个性化治疗选择,也可以教授一些防病保健的自我保健方法。中心的结合医学专家与其他专科医生一起,能针对慢性疼痛、肥胖、关节炎、情绪失常、疲劳、高血压、糖尿病、心脏病、癌症、肠功能紊乱、疑难杂症、焦虑、痛经或膀胱疼痛综合征、不孕症、更年期、外科手术准备和术后恢复等为病人提供服务。目前中心在马里兰大学医学院的家庭医学科设有针灸门诊,并开始为医学院的创伤急救中心(Shock Trauma Center)的急性创伤病人提供病房针灸治疗。目前中心还与创伤急救中心合作进行一项临床试验,观察针灸对急性创伤的影响和机制。

3  信息

为筛选高质量的补充医学研究证据以指导未来研究,由Eric Manheimer主任负责的信息研究部门,在世界范围内收集补充医学对疼痛[32]、关节炎[33]和其他病症[13,34]疗效的文献资料,对其进行系统评价,并且与国际Cochrane中心在补充医学领域进行合作。1996年Cochrane中心开始与马里兰大学医学院结合医学中心进行补充医学方面的合作。这项工作稳步进展,适应了补充与替代医学从业者以及公众日益增强的对这方面信息的需要,帮助他们辨别已发表的补充医学临床试验的疗效,撰写系统评价,训练系统评价者,为公众和医疗从业者宣传系统评价,并进行提高系统评价方法的研究。2007年5月,中心获得NIH一项为期5年的210万美元资助,用于支持发展该领域系统评价的研究。目前研究项目包括撰写系统评价,训练系统评价者,研究改善系统评价的方法。

4  教育

所有马里兰大学医学院的学生都可选修有关补充与替代医学的课程,结合医学教育也扩展到初级保健医生培训、职业训练以及继续医学教育。

马里兰大学结合医学中心所有教育项目的最终目的是使医学生认识到精神、身体和意识之间具有重要关系,认识自我保健和自我康复的重要性。目标是训练能够把病人看作整体,从常规现代医学及补充医学(整合医学)中找到最佳治疗方案的执业医生,同时也致力于培养结合医学领域的临床与基础科研人员。课程包括医学本科教育、住院医师培训、职业发展训练、进修培训以及继续教育研讨。

要建立一个杰出的结合医学研究中心存在很多挑战,其中一个重要因素是要有一个强有力的研究团队,他们不是只擅长西医研究方法却没有补充与替代医学知识的专家,也不只是些仅仅有临床经验但却没有研究经验的专家。马里兰大学医学院结合医学中心一直重视使补充与替代医学专家、有经验的临床医生如风湿病专家、方法学专家、临床试验专家和统计学专家组成一个团队共同合作进行试验设计、实施和评价。杰出研究中心一经成立,其重要任务之一就是培训下一代研究者,使他们在研究和临床两方面都成为专家。该中心不但培训美国本地区的研究人员,还接受和培训了包括中国上海和韩国在内的多位访问学者,他们参加中心的实验和研究,并与中心合作,参与发表了多篇SCI源期刊高质量文章[17,35-39]。

5  致谢

我们在此感谢NCCAM和NIH对马里兰大学医学院结合医学中心长期的资助和支持。

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樊蓥博士曾在该中心工作4年, 在劳力行博士领导下从事中药和针灸基础讲究。

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