Yet another form of acupuncture

Yet another form of acupuncture

Age cannot wither her, nor custom stale Her infinite variety.

I do not think Shakespeare was referring to acupuncture, but there appears to be an infinite variety of the intervention. I came across  Clinical randomized controlled trials of acupoint catgut-embedding for simple obesity: a meta-analysis in my feeds.

Catgut embedding? Yep


Catgut is a type of cord made from the natural fiber in the walls of sheep or goat intestines. Catgut is embedded on the acupuncture points to keep the points stimulated for about a week and then the fiber is absorbed by the body. The needles used for embed the catgut are thicker than classic acupuncture needles so it causes more pain than classic acupuncture.

It, like all other forms of TCM, has been used for thousands of years and its antiquity makes the 'why' of this particular form of acupunctures difficult to find. It is used for a hodgepodge of unrelated medical problems:

perimenopausal syndrome, chronic urticaria, depressive neurosis, refractory insomnia, obesity, sciatica, etc.

I particularly like the 'etc.' at the end, suggesting any and all medical problems are amenable to catgut embedding.

Another review suggests

Epigastric pain, obesity, epilepsy, asthma, abdominal pain, facial paralysis and constipation of the internal medicine, low back pain and leg pain of the surgical department, psoriasis of the dermatological department and blepharoplasty of the department of ophthalmology and otorhinolaryngology are considered as the dominant diseases for acupoint catgut-embedding therapy.

All processes with a common pathophysiology.  The procedure tends to make an inflammatory bump, making blind trials difficult. Only rare complications have been reported with what appears to be a foreign body reaction as well as

A woman in Greater Taichung had about 1,500 strings of catgut embedded in her body over a period of 15 months, leading recently to her nearly losing her life from the suppuration of about 10 wounds and cellulite complications

Its raison d’être appears to be obesity treatment and the most recent meta-analysis suggests

The eligible studies that met our inclusion criteria were all of evidence level I or II. Most of them used acupuncture as control group for evaluating the efficacy of catgut embedding and reveal the equality or superiority of catgut embedding, but there was no consistency in frequency or duration of treatment or numbers of sutures implanted.

Given the lack of blinding inherent in the intervention and the lack of biologic plausibility any positive results are unlikely to be due to direct effects of the catgut and due to nonspecific effects i.e. bias.  I would suspect that the usual caveat of

further comparative studies are both justified and necessary to provide more information on the best technique and more rigorous evidence on effectiveness.

is probably not needed.

But just when I think there can be no more odder ideas in pseudo-medicine, up pops another. Infinite variety indeed.

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Points of Interest 8/12/2014