基于循证医学针灸临床研究证据评价体系的初步构建

目的:基于循证医学理念和方法,初步构建针灸临床研究证据评价体系。方法:采用文献分析方法、专家访谈方法和共识性方法,结合针灸学科及文献特点,比对循证医学证据评价体系,探讨针灸研究证据的范畴和特点,建立针灸研究证据的评价方法。结果:研究确立了针灸研究证据的来源和范畴,建立了古籍载录证据、专家经验证据、现代随机对照试验、非随机对照试验、病例序列研究、个案报道的的质量评价方法,形成了针灸研究证据强度及推荐等级标准。结论:本文参考循证医学证据评价方法,初步地建立了符合针灸自身特点的针灸临床研究证据评价体系,可为针灸临床证据评价提供参考。

BP和Elman神经网络评价针灸治疗颈椎病疗效研究

基于PRO量表在针灸治疗颈椎病的不确定性和复杂性,需要综合多种因子去衡量,且因子与输出的关系是非线性的,而人工神经网络模型能够解决非线性问题且适合于动态系统辨识,于是分别构建BP和Elman人工神经网络,通过MATLAB软件运算,分析比较得出BP模型比Elman模型精度高,在针灸评价模型中效果更好。为针灸治疗颈椎病提供相关理论指导。

近10年针灸Cochrane系统评价文献可视化分析

[目的]通过可视化分析评估针灸系统评价的现状,分析针灸临床研究存在的问题。[方法]通过检索Cochrane Library数据库中2011年1月—2021年11月收录的针灸相关系统评价文献。主要干预方式为针灸、电针、穴位按压、经皮电刺激、艾灸,根据纳排标准筛选、建库统计。采用Excel、Cytoscape、Gephi软件进行可视化分析。[结果]共检索到329篇针灸系统评价文献,符合纳入标准88篇。文献发表国家集中在中国、澳大利亚、英国;发文机构主要集中在中国香港玛丽医院、澳大利亚帕克维尔皇家妇女医院等,机构间合作不紧密;作者以Daniel KL Cheuk、Caroline A Smith发文最多,作者间合作交流较少;以针灸防治疼痛管理的文献引用次数最多,其次是针灸防治偏头痛、穴位按压防治恶心呕吐等;治疗结果以针灸治疗痛症、泌尿生殖系统疾病、神经系统疾病为主;干预方式仍然以传统针灸为主;结果分布主要是阴性结果;证据充分度以低等证据为主。[结论]针灸低质量临床研究将影响针灸临床疗效和安全性评价,要不断明确针灸的最佳参数;不断完善针灸临床设计方案、选择合理的对照,完善针灸病种的核心指标集及针灸临床评价体系,提高针灸临床研究及论文的质量。

从一个针灸验方的变迁求穴位特异性研究难题之解

"条口透承山治疗肩周炎"长期以来作为当代针灸穴位临床应用新发现的代表,对国内外针灸学教科书及针灸临床均产生了深远的影响。本文通过对此验方从发掘到演变再到广为流行全过程的层层剖析,发现这一针灸治疗经验在传播、研究及应用中出现了种种失误,并在此基础上提出了当代针灸临床实验设计存在的主要问题及改进思路。

对国外大规模针灸临床疗效系统评价报告的分析

综合分析Cochrane Library系统评价数据库(CDSR)收录的针灸系统评价文献和部分国外发表的针灸临床系统评价文献,对其中存在的问题提出改进建议。2009年CDSR共评价67种疾病,37种已经得出初步结论。其中针灸的有效病种有7种,包括特发性头痛、慢性颈痛、青光眼、风湿性关节炎、化疗后的恶心呕吐、经皮电刺激治疗原发性痛经和膝骨关节炎,但大部分临床证据有待提高,其他30种疾病因证据不足尚不能得出结论。分析发现,已发表的大部分针灸临床系统评价研究结果认为针刺和假针刺疗效没有显著性差异,针刺的疗效相当于安慰剂疗效。因此建议加强针灸临床的科研设计,明确研究病种选择和研究目的的关系,对针灸临床研究加强过程管理和质量控制,加强针灸基础理论研究和针灸理论基本问题的实验研究,建立符合针灸临床特点的临床评价体系。

从三个著名案例看针灸临床研究的复杂性

"孔最穴治疗痔疮"、"迎香透四白治疗胆道蛔虫"、"条口透承山治疗肩周炎"作为当代针灸穴位临床应用新发现的三个代表,对国内外针灸学教科书及针灸临床均产生了深远的影响.本文通过对这三个案例的层层剖析,揭示了这三项针灸治疗经验在传播和研究过程中出现的明显失误,指出了当代针灸临床研究设计,特别是近年来国外著名医学刊物发表的针灸临床研究设计的主要问题,并提出了相应的改进思路.

System review on treating post-stroke depression with acupuncture

Objective To assess the efficacy and safety of treating post-stroke depression with acupuncture compared to western medicine systematically. Methods Databases were retrieved such as Cochrane Library, PubMed, Web of Sicence, EMbase, CBM, CNKI and WanFang Data so as to look up randomized controlled trials （RCT） of treating post-stroke depression with acupuncture and western medicine, and the time limit for the retrieval spanned from the date of database established to September 2013. By extracting data and evaluating methodological quality of included studies according to inclusion and exclusion criteria, RevMan 5.2 software was applied for Meta-analysis and evidence quality was assessed by adopting the GRADE system. Results Atotal of 23 RCTs （845 patients with post-stroke depression） were included in this study. It was revealed by Meta-analysis that the differences of the two groups were statistically significant in terms of HAMD scale scores measured at the end of the treatment by comparing the treatment of acupuncture and western medicine [SMD=0.26, 95% CI （0.11, 0.40）], but via susceptibility analysis （excluding low quality studies）, the differences were not statistically significant [SMD=-0.06, 95% CI （-0.37, 0.25）], and the reliability of the results was low; in terms of adverse events, the differences were statistically significant [RR= 0.32, 95% Cl （0.19, 0.53）], and the risk of adverse events reduced by 68% in the acupuncture group. From the assessment on evidence quality grade based on GRADE system, it was revealed that HAMD scores and adverse events were evidences with fairly low quality. Conclusion Although this system assessment showed that treating post-stroke depression with acupuncture was more effective compared with western medicine, the result was less reliable and quality of evidences was poor. The above-mentioned results need more high- quality randomized controlled trials for further verification.

Efficacy assessment for different acupuncture therapies in the treatment of frozen shoulder

Objective To explore better therapies for the treatment of frozen shoulder. Methods One hundred and seventy-four cases were divided into a filiform needle group （56 cases）, an electroacupuncture group （57 cases） and a warming needle group （61 cases） according to the randomized, controlled and single-blind study principles. Jiānqián （肩前 Extra）, Jiānyú （肩髃 LI 15）, Jiānliáo （肩髎 TE 14）, Nàoshū （臑俞 SI 10）, Wàiguān （外关 TE 5）, Hégǔ （合谷 LI 4） were used in all three groups but treated with filiform needle, electroacupuncture and warming needle technique respectively. The needles were retained for 30 min. It was given once every other day and 5 times constituted as one course. Pain indices and activity degree of shoulders were measured and recorded before and after treatment every time. Results The total effective rate was 93.0% （53/57） in the electroacupuncture group and 95.1% （58/61） in the warming needle group, both superior to that of 78.6% （44/56） in the filiform needle group （both P〈0.01）, but there was no significant difference between electroacupuncture group and warming needle group （P〉0.05）. After one course of treatment, the decline indices of shoulder pain of electroacupuncture group （4.28±0.22） and warming needle group （3.74±0.17） were both significantly greater than that of filiform needle group （2.78±0.18）（both P〈0.01）. And the decline indices of electroacupuncture group was also greater than that of warming needle group （P〈0.05）. The improvements of shoulder activity degree of warming needle group （76.92±5.53） and electroacupuncture group （60.37±3.80） were both greater than that of filiform needle group （42.50±3.67） （both P〈0.01）. And shoulder activity degree of warming needle group was also greater than that of electroacupuncture group （P〈0.01）. After one course of treatment, improvement of shoulder activity degree and decline indices of shoulder pain in these three groups were better than that after the first time treatment （all P〈0.01）. Conclusion All these three acupuncture therapies can achieve good therapeutic effects for frozen shoulder. The therapeutic effects of electroacupuncture and warming needle groups are superior to that of filiform needle group. All these three therapies could significantly reduce patients’ pain and improve their shoulder activity degree. The analgesic effect of electroacupuncture is the best, and the shoulder activity degree improved by warming needle is the best. The improvement of clinical therapeutic effect mainly depends on the therapy and the treatment times when the same acupoints are selected and the condition of illness are similar.

Overview of the acupuncture parts in the Cochrane Database of systematic reviews and the Cochrane Collaboration

Background The clinical efficacy of acupuncture is a topic that has received worldwide attention. In recent years, the rise of evidence-based medicine has led to calls for the clinical curative effects of acupuncture to be tested through objective, standardized, systematic evaluation. The results of systematic reviews for clinical trials on the efficacy of acupuncture directly affect the development of acupuncture medicine. Because of its rigorous methods and its capability to provide the very latest results, the Cochrane Database of Systematic Reviews（CDSR） is recognized worldwide as one of the most reliable sources for scientific evidence. Objective Assess the current system evaluation related to acupuncture in CDSR and the Cochrane Collaboration. Methods Based on the protocols described in the Cochrane library review and the Cochrane Collaboration, and considering the registered titles in the data base, the following key terms were selected： acupuncture, transcutaneous electrical nerve stimulation, electroacupuncture, needle and acupressure. Results The 275 articles were retrieved. According to inclusion and exclusion criteria, 139 articles were eventually chosen for inclusion. We found a growing number of acupuncture related CDSR annual reviews and protocols on the overall Before 2014. The published acupuncture related reviews, protocols and registered titles concerning the subject involve 34 Cochrane Review Groups. Through analyzing the 84 reviews related to acupuncture, we concluded that these studies show a rather low rate of efficacy overall for acupuncture. Of the 84, 19（22.62%） concluded that there is evidence for the efficacy of acupuncture,2（2.38%） showed acupuncture treatment were not more effective than controls and the remaining 63（75.00%） showed that the efficacy of acupuncture were uncertain. Conclusions By analyzing and summarizing the acupuncture reviews published in the CDSR before 2014, we found that current research shows acupuncture treatment is most effective for treating pain and related symptoms（57.89%）. However, studies showing lack of efficacy or uncertain results far outweighed the studies with positive results. We discuss the possible reasons for this and beleive it is related to the overall quality of research, poorly designed sham acupuncture, lack of standard procedures for locating points and needling, and lack of attention to individual differences.

Therapeutic Idea and Approaches to Obesity with Acupuncture

Combining the personal clinical practice, the authors of this article illustrated the basic principle of treating obesity with acupuncture, studied its therapeutic effect evaluation, and demonstrated the idea and approaches in clinical application. In addition, the authors concluded that syndrome differentiation was the treatment principle and correct approach was crucial to the final result.

Reporting quality and effect size comparison in randomized controlled trials of bo's abdominal acupuncture using CONSORT statement and STRICTA

OBJECTIVE: To evaluate the reporting quality of randomized controlled trials(RCT) that compared Bo's abdominal acupuncture with conventional body acupuncture, and compare the efficacy and safetybetweenthembyperforminga Meta-analysis.METHODS: All RCTs comparing Bo's abdominalacupuncture with conventional body acupuncture were included. English and Chinese databases were searched from their respective inceptions to March 2014. The reporting quality was assessed according to the "Consolidated Standards of Reporting Trials"(CONSORT) checklist for parallel RCTs and the revised "Standards for Reporting Interventions in Clinical Trials of Acupuncture"(STRICTA). A Meta-analysis was conducted to synthesize the effect sizes,and publication bias was evaluated by the Egger linear regression test using Stata.RESULTS: Ninety-seven studies were included, of which most lacked adequate reporting information, and 80.4% showed that the efficacy of abdominal acupuncture is superior to conventional body acupuncture, especially for the following diseases:lumbar disc herniation, cervical spondylosis, omarthritis and cervical vertigo, except simple obesity.Effect-sizes were controversial when evaluating different outcomes.CONCLUSION: The international standard CONSORT statement and STRICTA guidelines should be strictly applied when reporting acupuncture RCTs in the future. Abdominal acupuncture appears to be more effective compared with conventional body acupuncture for some diseases. However, further high quality blind RCTs using validated outcomeindexesandstandardreportingarewarranted.

Metrological Analysis and Evaluation of Acupuncture-Moxibustion Treatment for Diarrhea in Modern Literature

Objective： To review year 1957-2005 literature on acupuncture and moxibustion and explore point selection and methods for acupuncture-moxibustion treatment of diarrhea in order to provide objective and reliable data for research on acupuncture and moxibustion standardization. Methods： A comprehensive analysis was made by a method of metrological analysis according to the data from ＂China modem acupuncture-moxibustion information database＂. Results： Points Zusanli （ST 36）, Tianshu （ST 25） and Shenque （CV 8） were the most frequently used and the optimal combination for acupuncture-moxibustion treatment of diarrhea. Chronic adult diarrhea was often treated by moxibustion. Acute childhood diarrhea was often treated by point application and injection. Conclusion： Diarrhea is often treated by needling and moxaing methods in acupuncture-moxibustion treatment. It is proposed to use Zusanli （ST 36） and Tianshu （ST 25） as a basic prescription for acupuncture-moxibustion treatment of diarrhea and to select points according to the syndrome.

Exploration of the Clinical Regularity of Acupuncture and Moxibustion Treatment for Insomnia

Objective： To review year 1956-2007 literature and explore the regularity of points selection and methods for acupuncture-moxibustion treatment of insomnia. Methods： A comprehensive analysis was made by a method of metrological review according to the data from ＂China Modem Acupuncture-moxibustion Information Databank＂. Results： It is indicated that points Sanyinjiao （SP 6） and Shenmen （HT 7） were most frequently used. Acupuncture was the main treatment. Conclusion： It is suggested that Baihui （GV 20）, Sishencong （Ex-HN 1）, Sanyinjiao （SP 6） and Shenmen （FIT 7） were used as basic points for acupuncture-moxibustion treatment of insomnia, which is combined with point selection based on syndrome differentiation.

Acupuncture therapy for angina pectoris:a systematic review

OBJECTIVE： To assess the effectiveness and safety of acupuncture therapy for angina pectoris. METHODS： Randomized controlled trials （RCTs） concerned with acupuncture treatment of angina pectoris were identified by searching Academic Source Premier, MEDLINE, Science Citation Index Expanded, and three Chinese databases （China biol- ogy medicine database, China national knowledge infrastructure, and VlP database for Chinese techni- cal periodicals）. The valid data were extracted in ac- cordance with our inclusion and exclusion criteria. The main outcomes of the included studies were synthesized using Revman 5.1. RESULTS： Twenty-one articles on 16 individual studies were included and evaluated as having high or moderate risk of bias according to the stan- dards of the Cochrane Collaboration. Meta-analysis indicated that acupuncture combined with conven- tional drugs （ACCD） was superior to conventional drugs alone in reducing the incidence of acute myocardial infarction （AMI） [0R=0.18, 95%CI （0.04,0.84）, P=0.03]. Moreover, ACCD was superior to con- ventional drugs in the relief of angina symptoms [0R=4.23, 95%C/（2.73, 6..56）, P〈0.00001], and im- provement of electrocardiography （ECG） [0R=2.61, 95%C/（1.83, 3.73）, P〈0.00001]. Acupuncture by it- self was also superior to conventional drugs for angi- na symptoms [0R=3.59, 95%C/（1.76, 7.92）, P=0.0004] and ECG improvement [0R=3.07, 95%C/（1.54, 6.10）, P=0.001]. ACCD was superior to conventional drugs in shortening the time to onset of angina relief [WMD=-1.40, 95% CI （-1.65, -1.15）, P〈 0.00001]. However, the time to onset was signifi- cantly longer for acupuncture treatment than for conventional treatment alone [WMD=2A3, 95%O （1.63, 3.23）, P〈0.000 01]. CONCLUSION： ACCD reduced the occurrence of AMI, and both acupuncture and ACCD relieved an- gina symptoms and improved ECG. However, com- pared with conventional treatment, acupuncture showed a longer delay before its onset of action. This indicates that acupuncture is not suitable for emergency treatment of heart attack. Owing to the poor quality of the current evidence, the findings of this systematic review need to be verified by more RCTs to enhance statistical power.

Economic Evaluation of Treating Herpes Zoster with Various Methods of Acupuncture and Moxibustion

OBJECTIVE:To analyze the cost effect of surrounding acupuncture plus electric acupuncture,cotton-sheet moxibustion,puncturing with red-hot needles,tapping plus cupping on herpes zoster.METHODS:Five hundred patients with herpes zoster were randomly divided into group A(surrounding acupuncture plus electric acupuncture),group B(cotton-sheet moxibustion),group C(puncturing with red-hot needles),group D(tapping plus cupping),and group E(Western medicine).The treatment was carried out twice a day in group E and once a day in the other four groups.The curative effect was observed on the 10th day of treatment;the cost was calculated for the five therapies,and the cost-effect ratio(C/E) and increment ratio(△ C/△ E) were analyzed.RESULTS:After the 10-day treatment,there was no statistical difference(P>0.05) in the curative effect among the five groups.Pain being alleviated one day faster than in group E amounted to a saving of RMB 21.90 yuan in group A,a saving of RMB 21.87 yuan in group B,a saving of RMB 26.00 yuan in group C,and a saving of RMB 20.23 yuan in group D.Compared with group C,the values of △ C/△ E were RMB 1.55,2.81,and 0.21 yuan in groups A,B,and D,respectively.CONCLUSIONS:The curative effect in groups A,B,C,and D was similar to that in group E,but the C/E was better than in group E.

Analysis of Clinical Regularities in Acupuncture-moxibustion Treatment for Stomach Diseases in Recent 10 Years

Objective：To objectively and dynamically assess the therapeutic effects of acupuncturemoxibustion on stomach diseases by a review and statistical analysis of year 2000-2009 literature on acupuncture-moxibustion treatment for stomach diseases,facilitate the development of clinical acupuncturemoxibustion from the summarization of individual experience to the study of group experience and further exploit the advantages of acupuncture-moxibustion science.Methods：Statistical and expert analyses were made on the basis of the data from China Modem Acupuncture-moxibustion Information Databank.Results：There were 11 kinds of diseases in the acupuncture-moxibustion spectrum of stomach diseases.It was suggested that points Zusanli（ST 36）,Zhongwan（CV 12）,Weishu（BL 21）,Pishu（BL 20）,Neiguan（PC 6）and Sanyinjiao（SP 6）be used as a basic prescription for acupuncture-moxibustion treatment of stomach diseases and corresponding treatment be selected according to the character of each disease.Conclusion：acupuncturemoxibustion has a certain therapeutic effect on stomach diseases,but the clinical application and observed cases should be increased.