A weekly email from the NIH’s National Library of Medicine posting search results for the term “acupuncture” recently turned up this gem of a journal article:

Effect of acupoint catgut embedding in chronic fatigue syndrome patients: A protocol for a systematic review and meta-analysis

Most of the authors are associated with the Acupuncture-Moxibustion School of Chengdu University of Traditional Chinese Medicine or its affiliated hospital. I predict one of two possible outcomes: (1) the results will be inconclusive (but perhaps “promising”), thus more research is needed, or (2) the authors will conclude that acupoint catgut embedding is safe and effective treatment for chronic fatigue syndrome (CFS), because GIGO. What I can guarantee is they will not decide that the whole affair is tooth fairy science, that acupoint catgut embedding is fantasy-based, and that there is no reason whatsoever to consider it for CFS, or for anything else for that matter.

Those were not my first thoughts on reading the title however. My initial reaction was: What the hell is “acupoint catgut embedding”?

As it turns out, this is not the first appearance of acupoint catgut embedding on SBM. Back in 2014, former SBM blogger Mark Crislip set out to satisfy his curiosity:

I have wondered, how many variations of acupuncture are there? I suspected a lot, but I thought I would go looking and make a list. Since acupuncture is not based in reality but is instead a collection of pseudo-knowledge, there is no reason for acupuncture to have fidelity to fundamental concepts.

All told, he found 32 different styles, “double or triple if you want to add electricity or lasers to an existing style. More if you add a particular style of needle manipulation”. And there we find, listed just after (deadly) bee venom acupuncture, catgut acupuncture, as it is also known.

But what, exactly, is catgut acupuncture? Let’s break this down into its two components.

From Wikipedia:

Catgut (also known as gut) is a type of cord that is prepared from the natural fiber found in the walls of animal intestines. Catgut makers usually use sheep or goat intestines, but occasionally use the intestines of cattle, hogs, horses, mules, or donkeys. Despite the name, catgut manufacturers do not use cat intestines.

[References omitted.]

Catgut’s primary uses are for stringed instruments, tennis racquet strings, and surgical sutures, although for all of these it has given way to other materials, such as synthetics.

Acupuncture is a theatrical placebo based on pre-scientific notions of anatomy and physiology. It proposes a system of “meridians” throughout the body carrying “qi”, or energy, which, when blocked, causes disease and other maladies. Unblocking the flow of this energy by sticking needles in “acupoints” located all over the body (although there is no agreement on where they are) is the putative point of acupuncture.

So, catgut acupuncture does not involve actual cats, although there is such a thing as cat acupuncture.

Putting the two together, catgut acupuncture is, according to one article:

a new method of acupuncture which has developed in the recent 3 decades. Catgut . . . is embedded in the acupuncture points and enhanced the point stimulation for 7-14 days. Catgut implantation is one kind of acupuncture, where specific acupuncture points are gently and continuously stimulated till the ailment is improved and designed results are achieved.

Apparently the idea is that if briefly sticking something in an acupoint is beneficial, sticking something in an acupoint for 7-14 days is even better.

But how does it “work”? From 5,000 papers collected in a literature search of the China Academic Journal Network Publishing Database, the authors of this article

summarized that TCM effect mechanism of catgut-point embedding therapy includes the effects of needle retaining and embedding, harmonizing yin and yang, balancing zangfu organs, promoting meridian qi, regulating qi and blood, tonifying for the deficiency and reducing for the excess, strengthening the antipathogenic qi and eliminating pathogens. From the point of view of western medicine, the effect mechanism of catgut-embedding therapy refers to recovering nerve function, regulating neural reflex, increasing human immunity, improving local circulation, inhibiting the release of inflammatory factors, reducing apoptosis, regulating cellular factor and improving body metabolism. It was found that the effects of catgut-embedding therapy were not only related to the effects induced by common acupuncture, but also to the persistent treatment through prolonged stimulation duration, especially in the treatment of chronic diseases with many systems involved.

Really, one could hardly ask for more. But, of course,

further studies are requested.

Because all of this is made up, other authors apparently feel free to fabricate different explanations, here again from the “western” perspective:

AE [acupoint embedding] artificially creates a mild inflammation and activates the interaction of the immune system with the neuroendocrine system.

Well, which is it: Does catgut acupuncture inhibit the release of inflammatory factors or does it create a mild inflammation?

As is claimed for needle acupuncture, catgut acupuncture is a virtual panacea. Proponents tout it (based on unconvincing studies, such as those with an A+B versus A design) for IBS, obesity, postmenopausal osteoporosis, insomnia, diabetes and “its common chronic complications”, post-adolescent acne, ulcerative colitis, joint attention and social communication in children with autism spectrum disorder, dysmenorrhea, allergic rhinitis, and intractable facial paralysis, among other disparate conditions lacking a common etiology or any other reason to think a single therapy would be effective for all.

But scientific progress marches on, at least, for those promoting pseudoscience, when it’s convenient. As has happened in surgery, newer materials may replace catgut in acupoint embedding because “catgut induces a variety of immune responses, including allergic reactions and subcutaneous nodules”. This led researchers to try polyglactin 910, a synthetic suture material, in patients with chronic pain from cervical spondylotic radiculopathy because acupoint catgut embedding in the neck had already proven to have “significant therapeutic effects”. And guess what? The new material worked like a charm!

I can’t find that catgut acupuncture has taken off in the U.S. This may be because – and this is a guess – sutures are medical devices regulated by the FDA and acupoint embedding employing catgut or any other suture material is not an FDA-approved use. This is not to say that the federal government might not be willing to permit it, given the fact that the Department of Health and Human Services (the FDA’s parent agency) has already demonstrated it is happy to ignore the lack of evidence in announcing Medicare coverage for acupuncture.

I suppose the only certainty here is that, given the near-infinite variety that can be shoehorned into fantasy-based paradigms like acupuncture, we can expect even more iterations, all supported by nonsensical mechanisms of action and dubious “studies”.


Posted by Jann Bellamy

Jann J. Bellamy is a Florida attorney and lives in Tallahassee. She is one of the founders and Board members of the Society for Science-Based Medicine (SfSBM) dedicated to providing accurate information about CAM and advocating for state and federal laws that incorporate a science-based standard for all health care practitioners. She tracks state and federal bills that would allow pseudoscience in health care for the SfSBM website.  Her posts are archived here.