Content analysis of systematic reviews on effectiveness ofTraditional Chinese Medicine

OBJECTIVE:To evaluate evidence for the efficacy of Traditional Chinese Medicine(TCM) in systematic reviews.METHODS:Chinese(TCM Periodical Literature Database,Chinese Biological Medicine database,Chinese Medical Current Contents,China Hospital Knowledge Database journal fulltext database,Virtual Machining and Inspection System,and Wanfang) and English(Cochrane Database of Systematic Reviews,PubMed and Embase) databases were searched.RESULTS:Three thousand,nine hundred and fifty-five articles were initially identified,606 of which met the inclusion criteria,including 251 in English(83 from the Cochrane Database) and 355 in Chinese.The number of articles published each year increased between 1989 and 2009.Cardiocerebrovascular disease was the most studied target disease.Intervention measures included TCM preparations(177 articles),acupuncture(133 articles) and combinations of TCM and Western Medicine(38 articles).Control measures included positive medical(177 articles),basic treatment(100 articles),placebo(219 articles),and blank and mutual(107 articles).All articles included at least one reference;the greatest number was 268.Six of 10 articles with high quality references demonstrated curative effectsagainst target diseases including upper respiratory tract infection,dementia and depression.Interventions that were not recommended were tripterygium for rheumatoid arthritis and TCM syndrome differentiation for pediatric nocturia.In 10.4% of the studies,the authors concluded that the intervention had a curative effect.The assessors agreed with the authors' conclusions in 88.32% of cases,but rejected 8.94%(54 articles).CONCLUSION:1) Training in systematic review methods,including topic selection,study design,methods and technology,should be improved.2) Upper respiratory tract infection,dementia and depression may become the predominant diseases treated by TCM,and the corresponding interventions could be developed into practical applications.3) Use of non-recommended interventions should be controlled,and there should be more research on side effects.

Review of controlled clinical trials on acupuncture versus sham acupuncture in Germany

OBJECTIVE: To examine German controlled clinical trials on the therapeutic effects of acupuncture vs sham acupuncture, and to find whether there are problems with the conclusion that sham acupuncture has no significant deviation from acupuncture. METHODS: We focused on literature from the last ten years (2002-2011) included in PubMed about controlled clinical trials on acupuncture vs sham acupuncture carried out in Germany. The methods applied in sham acupuncture are summarized, and the difference between the acupuncture and sham groups were analyzed. We measured effects based on the following criteria: acupuncture is effective and superior to sham, acupuncture is effective but similar to sham, both of them have uncertainty regarding treatment effect, or no significant effect. Finally, we reviewed the hypotheses of different scholars on sham acupuncture and analyzed their results.RESULTS: Four types of controlled clinical trials including sham acupuncture on non-Traditional Chinese Medicine acupoints, minimal acupuncture on non-acupoints, placebo needle and sham laser acupuncture had varying results in the 57 articles analyzed. Some showed that acupuncture had a better effect than sham, while some suggest acupuncture and sham had similar effects. In all studies using sham acupuncture on non-therapeutic points, sham electrodes, and sham electro-acupuncture, the therapeutic effect was better than sham. Of the trials, 37 demonstrated that acupuncture had a better effect than sham acupuncture. Only nine trials found no significant difference between acupuncture and sham. Two controlled trials for the same condition (neck pain) conducted by two different German research institutes used the same control method, but reached contradictory conclusions. CONCLUSION: We found problems in conclusions based on results of controlled clinical trials of sham acupuncture in Germany. Therefore, there is still not enough evidence to support the statements that "acupuncture and sham acupuncture have no difference in treatment effect" and "acupuncture is just a placebo effect." The control methods of sham acupuncture used in Germany may not be standardized and may not be suitable for acupuncture clinical trial research. We suggest that research on the methodology of sham acupuncture should be given priority in the design of acupuncture trials in the future.