MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

Acupuncture-moxibustion therapy (AMT) is a so-called alternative medicine (SCAM) that has been used for centuries in treatment of numerous diseases. Some enthusiasts even seem to advocate it for chemotherapy-induced leukopenia (CIL)  The purpose of this review was to evaluate the efficacy and safety of acupuncture-moxibustion therapy in treating CIL.

Relevant studies were searched in 9 databases up to September 19, 2020. Two reviewers independently screened the studies for eligibility, extracted data, and assessed the methodological quality of selected studies. Meta-analysis of the pooled mean difference (MD) and risk ratio (RR) with their respective 95% confidence intervals (CI) were calculated.

Seventeen studies (1206 patients) were included, and the overall quality of the included studies was moderate. In comparison with medical therapy, AMT has a better clinical efficacy for CIL (RR, 1.24; 95% CI, 1.17-1.32; P < 0.00001) and presents advantages in increasing leukocyte count (MD, 1.10; 95% CI, 0.67-1.53; P < 0.00001). Also, the statistical results show that AMT performs better in improving the CIL patients’ Karnofsky performance score (MD, 5.92; 95% CI, 3.03-8.81; P < 0.00001).

The authors concluded that this systematic review and meta-analysis provides updated evidence that AMT is a safe and effective alternative for the patients who suffered from CIL.

A CIL is a serious complication. If I ever were afflicted by it, I would swiftly send any acupuncturist approaching my sickbed packing.

But this is not an evidence-based attitude!!!, I hear some TCM-fans mutter. What more do you want that a systematic review showing it works?

I beg to differ. Why? Because the ‘evidence’ is hardly what critical thinkers can accept as evidence. Have a look at the list of the primary studies included in this review:

  1. Lin Z. T., Wang Q., Yu Y. N., Lu J. S. Clinical observation of post-chemotherapy-leukopenia treated with ShenMai injectionon ST36. World Journal of Integrated Traditional and Western Medicine2010;5(10):873–876. []
  2. Wang H. Clinical Observation of Acupoint Moxibustion on Leukopenia Caused by Chemotherapy. Beijing, China: Beijing University of Chinese Medicine; 2011. []
  3. Fan J. Y. Coupling of Yin and Yang between Ginger Moxibustion Improve the Clinical Effect of the Treatment of Chemotherapy Adverse Reaction. Henan, China: Henan University of Chinese Medicine; 2013. []
  4. Lu D. R., Lu D. X., Wei M., et al. Acupoint injection with addie injection for patients of nausea and vomiting with cisplatin induced by chemotherapy. Journal of Clinical Acupuncture and Moxibustion2013;29(10):33–38. []
  5. Yang J. E. The Clinical Observation on Treatment of Leukopenia after Chemotherapy with Needle Warming Moxibustion. Hubei, China: Hubei University of Chinese Medicine; 2013. []
  6. Fu Y. H., Chi C. Y., Zhang C. Y. Clinical effect of acupuncture and moxibustion on leukopenia after chemotherapy of malignant tumor. Guide of China Medicine2014;12(12) []
  7. Wang J. N., Zhang W. X., Gu Q. H., Jiao J. P., Liu L., Wei P. K. Protection of herb-partitioned moxibustion on bone marrow suppression of gastric cancer patients in chemotherapy period. Chinese Archives of Traditional Chinese Medicine2014;32(12):110–113. []
  8. Zhang J. The Clinical Research on Myelosuppression and Quality of Life after Chemotherapy Treated by Grain-Sized Moxibustion. Nanjing, China: Nanjing University of Chinese Medicine; 2014. []
  9. Tian H., Lin H., Zhang L., Fan Z. N., Zhang Z. L. Effective research on treating leukopenia following chemotherapy by moxibustion. Clinical Journal of Chinese Medicine2015;7(10):35–38. []
  10. Hu G. W., Wang J. D., Zhao C. Y. Effect of acupuncture on the first WBC reduction after chemotherapy for breast cancer. Beijing Journal of Traditional Chinese Medicine2016;35(8):777–779. []
  11. Zhu D. L., Lu H. Y., Lu Y. Y., Wu L. J. Clinical observation of Qi-blood-supplementing needling for leukopenia after chemotherapy for breast cancer. Shanghai Journal of Acupuncture and Moxibustion2016;35(8):964–966. []
  12. Chen L, Xu G. Y. Observation on the prevention and treatment of chemotherapy-induced leukopenia by moxibustion therapy. Zhejiang Journal of Traditional Chinese Medicine2016;51(8):p. 600. []
  13. Mo T., Tian H., Yue S. B., Fan Z. N., Zhang Z. L. Clinical observation of acupoint moxibustion on leukocytopenia caused by tumor chemotherapy. World Chinese Medicine2016;11(10):2120–2122. []
  14. Nie C. M. Nursing observation of acupoint moxibustion in the treatment of leucopenia after chemotherapy. Today Nurse2017;4:93–95. []
  15. Wang D. Y. Clinical Research on Post-chemotherapy-leukopenia with Spleen-Kidney Yang Deficiency in Colorectal Cancer Treated with Point-Injection. Yunnan, China: Yunnan University of Chinese Medicine; 2017. []
  16. Gong Y. Q, Zhang M. Q, Zhang B. C. Prevention and treatment of leucocytopenia after chemotherapy in patients with malignant tumor with ginger partitioned moxibustion. Chinese Medicine Modern Distance Education of China2018;16(21):135–137. []
  17. Li Z. C., Lian M. J., Miao F. G. Clinical observation of fuzheng moxibustion combined with wenyang shengbai decoction in the treatment of 80 cases of leukopenia after chemotherapy. Hunan Journal of Traditional Chinese Medicine2019;35(3):64–66. []

Notice anything peculiar?

  • The studies are all from China where data fabrication was reported to be rife.
  • They are mostly unavailable for checking (why the published adds links that go nowhere is beyond me).
  • Many do not look at all like randomised clinical trials (which, according to the authors, was an inclusion criterion).
  • Many do not look as though their primary endpoint was the leukocyte count (which, according to the authors, was another inclusion criterion).

Intriguingly, the authors conclude that AMT is not just effective but also ‘safe’. How do they know? According to their own data extraction table, most studies failed to mention adverse effects. And how exactly is acupuncture supposed to increase my leukocyte count? Here is what the authors offer as a mode of action:

Based on the theory of traditional Chinese medicine (TCM), CIL belongs to the category of consumptive disease, owing to the exhaustion of genuine qi in the zang-fu viscera and the insufficiency of kidney essence and qi-blood. Researchers believe that there is an intimate association between the occurrence of malignant tumors and the deficiency of genuine qi. During attacking the cancer cells, chemotherapeutics also damaged the function of zang-fu viscera and qi-blood, leading to CIL. According to the theory of TCM and meridian, acupuncture-moxibustion is an ancient therapeutic modality that may be traced back more than 3500 years in China. Through meridian conduction, acupuncture-moxibustion therapy stimulates acupoints to strengthen the condition of zang-fu viscera and immune function, supporting genuine qi to improve symptoms of consumption.

I think it is high time that we stop tolerating that the medical literature gets polluted with such nonsense (helped, of course, by journals that are beyond the pale) – someone might actually believe it, in which case it would surely hasten the death of vulnerable patients.

7 Responses to Acupuncture for chemotherapy-induced leukopenia? It’s time to stop such dangerous nonsense

  • Notably no-one seems to suggest acupunture instead of chemotherapy, for cancer. That would quickly show its level of efficacy, zang-fu viscera or no zang-fu viscera…….

  • You are absolutely right. Unfortunately SCAM is increasingly polluting not only the medical literature but also the whole medical scene – hospitals, clinics, specialties and everywhere else are increasingly polluted with SCAM entities pretending to be legitimate medicine and the general public are unable to tell them apart.

    Sadly it seems that most conventional medical practitioners are sadly ignorant of the real nature of SCAM and take the view that it is either harmless placebo or that it may have some mild genuine effect. But they are happy to give it a pass without bothering to look into its real provenance or considering its deleterious effects or the damage it does to the public understanding of science or the undermining effect it has on real medicine.

    Once people start to believe in the nonsense of Reiki, or the mystical mumbo-jumbo of homeopathy they start down a dangerous rabbit hole of make-believe and hocus-pocus and are increasingly lead astray by devious and deliberate attempts to mislead and obfuscate. From there the well-worn path to double-dealing and conspiracy theories can easily lead them to any number of SCAMs – and sadly once a believer in one they are much more likely to believe in another.

    That is why I believe it is so important for all medics and scientists to oppose SCAM in all its forms and to try to expose it for the lie that it is. It is NOT a harmless placebo or a benign diversion – it is on the contrary a very harmful pseudoscience that diverts attention and funding quite uselessly from genuine scientific enquiry and exposes people to perfectly useless, unnecessary and potentially dangerous “treatments” that have been repeatedly demonstrated to have no practical use when instead they would be better off either with no treatment or with a treatment that has an evidence base.

    Practitioners who continue to push these “SCAM treatments” either are or ought to be aware that there are more effective evidence based treatments available and so the only reason for pushing SCAM is for profit. Accordingly this has to be unethical and unprofessional and really should qualify as malpractice in my view. Therefore these SCAM treatments ought to stop. There is simply no excuse for treating anyone with acupuncture or homeopathy or any of these other therapies.

    It is high time that we stopped beating about the bush and just came out and stated this clearly. SCAM treatments are rubbish – they don’t work full stop. Therefore they ought to be stopped. The fact that out of tens of thousands of studies there are a handful of not very good ones that show some minor effects is pretty crap really isn’t it? What kind of a p value is that? And given that say most acupuncture studies come out of China and that nearly all acupuncture studies out of China are positive – then what would one expect????

    Most SCAM studies are pretty crap anyway – poorly designed, very small numbers, A vs A + B, so it will always be positive, no adverse effects reported and so on.
    And whatever the result they will ALWAYS spin it as being positive.
    And they will ALWAYS say – more studies are needed!
    But NO – no more studies are needed – SCAM is crap. No more studies – just throw the whole lot in the bin and forget it.

  • I would just like to underline what a problem chemotherapy-induced leukopenia can be.

    Most chemotherapy drugs temporarily reduce the activity of the bone marrow, including the production of white blood cells, but also platelets and red blood cells. Each cell type has a limited lifespan in the blood, and the most abundant type of white blood cell, neutrophils, only last for a few days. Each dose of chemotherapy is therefore followed by a fall in the neutrophil count as the old ones reach the end of their life and the new ones aren’t yet ready to be released from the marrow. When the neutrophil count drops below a certain level we call it neutropenia (leukopenia is a more general fall in white blood cells, but it is mainly the neutrophils that are important here – lymphocytes have a longer lifespan and serious compromised of lymphocyte count and function is not normally a problem with most chemotherapy regimens).

    Neutrophils are essential for fighting certain kinds of bacterial infection, and neutropenic patients are very vulnerable during those few days of their chemotherapy cycle (typically some time during the second week), when even bacteria normally present in the body can cause infections. Neutropenia with a fever is a common oncological emergency, and provided that broad-spectrum intravenous antibiotics are started immediately there is not usually a problem. However, if the symptoms of infection are ignored, then the patient can deteriorate very quickly. Death can follow within as little as 18 hours of the first sign of trouble. Even bacteria normally found on the skin or in the mouth can cause an infection in the absence of white blood cells to keep them in check.

    Deficiencies in other components of the immune system, such as lymphocyte function, T-cell ratios, antibody production etc. can also occur, but usually only after prolonged treatment with relatively high doses of chemotherapy such as used by haematologists for the various types of leukaemia and lymphoma. They bring a risk of so-called opportunistic infections, with viruses, fungi and parasites that do not cause illness otherwise.

    These days we have drugs such as filgrastim, a synthetic version of one of the body’s controls over white cell production and maturation, which can be given prophylactically to prevent leukopenia, or therapeutically to reverse it (though it takes 48 hours to work). More importantly, at least in the UK, we also now have 24-hour helplines for our patients, manned by the Acute Oncology team, enabling neutropenic fever and other emergencies to be dealt with promptly by specialists, rather than the admitting medical team, who may not realise the urgency of the situation.

    Nevertheless deaths from chemotherapy-induced febrile neutropenia do still occur, and are feared by all oncologists. The horror of watching somebody die as a result of the treatment we have given them is an experience that we all share.

    In hospital, neutropenic patients (febrile or not) are reverse barrier nursed to prevent them acquiring infections from staff (think of the precautions used in managing Covid-19 patients and you get the idea). At home, they are advised to take precautions against avoiding large groups of people and anybody with a suspectied infection. The idea of a probably unshielded acupuncturist deliberately breaching the skin of a neutropenic patient, their main barrier against infection, and introducing skin bacteria into the body makes my blood run cold.

  • I think it is wonderful to have thoughtful skeptics such as Edward chiming in on all matters science and medicine.
    It is these rigid perspectives that allow us to gauge the reluctance of the human mind to truly appreciate the evolution of scientific understanding and progress. These are the perspectives that remind us of our inherent limitations of discovery when we continue to use the same tools for exploration in science while expecting to obtain different or new results.
    The wonderful thing about being a well trained physician is the decades of actual hands on experience one obtains with ones gifts; and to be sure- not all physicians are made of the same stuff. Most are technicians; a few are actually gifted healers and they and their patients live through the “miracles” so often disregarded by the vocal detractors. Physics as these technicians appreciate it in medicine, is very mechanistic and formulated, as it must be. Yet to believe one knows all as a result of this limited view of physics is to deny oneself the opportunity for real discovery; real discovery similar in spirit to Einstein and his Newtonian peers.

    • And I think it is wonderful to find people who cannot even get my name right – not to speak of more important things such as understanding the need for good evidence in healthcare.

    • In my obervation over the years (in the UK), GPs are clever, and holistic, in their approach, and most CAM practitioners are not, and not.

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