Clinical Acupuncture and Oriental Medicine最新文献

Dilatation of the chambers of the heart, which can be caused by a variety of factors, is always seen as serious heart pathology. The enlargement of the left ventricle inevitably leads to its loss of the systolic function, which, in turn, results in dyspnoea, fatigue, tachycardia and edemas. Widening of the right heart is almost surely a sign of pulmonary hypertension. The dilatation of the left atrium is most often seen, through temporary pacing, to be resistant to medical therapy. The most radical and effective way to solve the problem is via transplantation of the heart. The present case study involves successful treatment of heart dilatation and heart insufficiency caused by thyrotoxicosis by means of a short course of acupuncture. Results have been confirmed by methods routinely used in cardiology. Long-term effects of the treatment are also presented.

Objective: To determine the effect of Traditional Chinese Therapeutic Massage on individuals with neck pain.

Design: Randomized controlled clinical trial.

Setting: University laboratory.

Participants: Thirty-one volunteers with neck pain and loss in range of motion, for longer than one year were recruited from California State University staff and faculty. A total 28 subjects completed the study.

Intervention: Traditional Chinese Therapeutic Massage (TCTM) and a home based, self-administrated exercise program.

Main outcome measurement: A previously published neck pain questionnaire was used to measure pain intensity and the quality of life. A neck range of motion test was used to assess the changes in neck flexibility.

Results: The TCTM group had a significant reduction in the scoring of pain questionnaire (p<0.05) and significant improvement in ROM (p<0.05), after 6 week’s treatment, and after 6 week’s follow-up. The exercise plus TCTM appeared to be equally effective as TCTM alone.

Conclusion: Traditional Chinese Therapeutic Massage provided significant benefit to those suffering from neck pain. Further studies need to address the combination of the treatments using TCTM and the therapies in mainstream medicine.

In this brief paper the author highlights a number of issues involved in the investigation of traditionally based systems of acupuncture. Issues of authenticity and scholarship are discussed. Selecting clinical research models to match the type of question asked are discussed. The author also suggests a number of research models and a checklist of criteria that may be necessary for randomized controlled clinical trials of acupuncture exploring the relationship between clinical efficacy and the specific traditional diagnosis-treatment interventions used.

The diagnostic processes of Traditional Chinese Medicine (TCM) are fundamental to the practice of acupuncture. A review was conducted of some central issues underlying pattern differentiation and the integration of the TCM diagnostic system into acupuncture research. Problems with diagnostic reliability and the implications for clinical trials are discussed. Future research should include diagnostic reliability studies and the development of strategies for improving diagnostic reliability within acupuncture clinical trials.

Placebo controlled trials are used to examine the relative size of the specific effects of a therapy. When the therapy is a manual treatment like acupuncture, placebo control models are very complex due to the range of non-specific effects that can occur and issues such as blinding. This article examines ten different research models that have been used to control for placebo or other non-specific effects in clinical trials of acupuncture. Through an examination of the different non-specific effects that can occur in acupuncture therapy, it explores the relative ability of these ten models to control for the placebo and other non-specific effects. Three models are eliminated as probably unable to adequately control for these effects and therefore unable to explore the specific effects of acupuncture. The strengths and weaknesses of the remaining seven models are analyzed. Finally, methods and assessments needed to control for non-specific effects are discussed so that these seven models can be used to control for these effects and thus the models can examine the specific effects of acupuncture treatment.

Objective: To study the various methods and levels of blinding in acupuncture research. Data sources: Reference lists of the most recent systematic review of acupuncture on pain, systematic search of MEDLINE from 1966 to August 2000, CINAHL from 1982 to August 2000, and HealthSTAR from 1975 to August 2000.

Study selection: Randomized studies were included if they evaluated the effectiveness of acupuncture in painful conditions using a blinded design.

Data extraction: The hard copy of each of the eligible studies available was reviewed. The following information was extracted: name of first author, publication year, study design, blinding testing, treatment sham group received, and the outcome measures.

Data synthesis: There were 19 studies identified. They were described as ‘double blinded’ by the authors, referring to blinding of patients and evaluators. Sixteen studies did not perform any blinding testing after the treatments were over. Only three studies provided information that the blinding of patients was successful. These three studies used different questionnaires to assess the success of blinding. There was no study that evaluated the success of blinding of treatment evaluators. Also, no study attempted blinding of the treating acupuncturists.

Conclusions: Proper blinding of patients and evaluators is possible in acupuncture research and many different techniques of proper blinding exist. Assessment of blinding is a critical aspect of any sham or placebo controlled trial and should be routinely incorporated into the design of such trials of acupuncture.

The evaluation of traditionally-based systems of acupuncture (TBSA) is complex. However, we can assess specific measurement techniques and the diagnostic consistency of traditional Chinese medicine. In the context of randomised controlled trials, the intrinsic value of individual diagnostic systems versus general formulaic prescriptions for specific conditions needs to be carefully thought through, and an individual trial methodology based on the structure of each research proposal needs to be developed. The implications of evaluating TBSAs are discussed in this paper, although it is clear that we have as yet no clear answers to these complex issues.