Clinical Acupuncture and Oriental Medicine最新文献

Objective: To evaluate and introduce the current status of acupuncture clinical trials in Japan.

Methods: We performed a database search of controlled clinical trials (CCTs) published in Japan, using ‘Igaku Chuo Zasshi (Japana Centra Revuo Medicina) CD-ROM version (between 1987–2000)’ and an independent search. Parallel or crossover designed trials which assessed the efficacy of needle acupuncture were included.

Results: We located 32 published papers (24 full papers and eight abstracts), which reported 34 trials. Only two of these were listed in Medline or the Cochrane Library. Conditions examined were musculoskeletal pain (20 trials including 10 for low back pain and three for sciatica), neck and shoulder stiffness (four trials) and miscellaneous conditions (10 trials). Thirty-three trials were described as randomized, although seven trials employed a quasi-random method. Applying the 5-point Jadad quality assessment scoring system, the mean score was 1.85 ± 1.16 (SD). Eighteen (53%) of the reports were conducted to determine a more effective procedure of acupuncture, these compared a certain type of acupuncture with another type of acupuncture or specific additional points.

Conclusions: Japanese acupuncture CCTs, which are rarely listed in the Western databases, differ in several respects from Western reports. Systematic reviews including non-English papers with collaboration among authors representing different languages would promote more thorough scientific evaluation of complementary and alternative medicine.

Chinese medical theory and complexity theory are two distinct bodies of knowledge concerned with the nature and behavior of natural systems. The former is an artifact from mankind's ancient past; the latter is a vanguard of contemporary science. Yet the basic principles and modes of thinking in these two subjects can be productively compared and employed to make connections between ideas and individuals from apparently disparate backgrounds. These connections may provide insights to all involved. This paper presents some basic comparisons and explores potential ways to begin to construct links between a millennia-old method of traditional medicine and methodologies that lie at the frontiers of modern scientific knowledge. Topics addressed include: the dilemma facing modern Western medicine, the methodology of Chinese medicine, relationships between Chinese medicine and complexity theory, keys to further research, including: language and terminology, analysis of medicinal formulas, analysis of diagnostic and therapeutic principles and procedures, and the application of the metaphoric mode of thinking of Chinese medicine to the investigation of complex adaptive systems. Finally, there is a statement of principles that should be borne in mind by researchers in development of detailed guidelines and criteria for the design of studies and the evaluation of results.

Systematic reviews of randomized controlled trials, rather than narrative reviews, generally provide the approach that is least subject to bias for assessing the efficacy and effectiveness of a therapy. But despite their increasing use, systematic reviews are not free of problems, particularly when used to assess the evidence for acupuncture. Common weaknesses are inadequate literature searches and unclear inclusion criteria, including absence of a definition of ‘acupuncture’ for delineating the scope of the review. In addition, the adequacy of the acupuncture performed in the trials is often not addressed. Overall, there is little consistency in the criteria used for critiquing the included trials. The validated five-point, and expanded nine-point, Jadad scales for assessing trial quality are discussed, especially in regard to their emphasis on double blinding that can be applied to acupuncture trials if ‘double blind’ is defined as patient and assessor blinding. Suggestions are made for avoiding each of the above-cited problems for future systematic reviews, which should include an acupuncture specialist in the author team. For the near future, however, there is a greater need for new high-quality RCTs of acupuncture than for additional systematic reviews of existing trials.