Clinical Acupuncture Research Research Articles

Discussion on the curative effect of acupuncture for polycystic ovarian syndrome

Discussion on the negative result of the paper “Effect of acupuncture and clomiphene in Chinese women with polycystic ovary syndrome: a randomized clinical trial” from Chinese experts were organized, and experts from Beijing, Nanjing, Chengdu who's major were clinical acupuncture, acupuncture research and gynecology have made their points. In-depth discussion were made by the experts from the perspective of confirmation of therapeutic program, selection of outcome indices, application of statistical analysis, the illustration of research results and clinical effects. The experts have pointed out that the negative result is commonly seen in medical research and the key point is to find out the defects of the trial so as to modify the research orientation and better serve the clinical practice.

Literature regarding clinical research of acupuncture for depression in the worldwide:comparison and discussion

The literature regarding clinical research of acupuncture for depression published in Wanfang database, VIP database, CNKI database and PubMed from January of 2004 to March of 2005 was collected, and the quality of randomized controlled trial (RCT) that met the inclusive criteria was evaluated with Jadad. The research designs (research objective, intervention, effect assessment) were compared and analyzed by using the 2010 version of Consolidated Standards of Reporting Trials (CONSORT) and Standards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA). As a result, a total of 57 articles were included in the comparative study, 46 of which were RCTs (36 articles were published in China core journals, 6 articles written by China were published in foreign countries, and 4 articles were foreign researches). It was found the literature of Chinese researches attached great importance to the syndrome differentiation of acupuncture, and various types of acupuncture intervention and biological effect indicators were applied; the literature of foreign researches presented advantages on RCT quality, and the baseline evaluation and effect evaluation systems were more comprehensive, in addition, more attention was paid to quantitative design of clinical parameters. It was concluded the differences between Chinese and foreign clinical research of acupuncture for depression were unfavorable for the evidence-based research, and the overall quality of researches was in need of improvement. It was recommended the future researchers should be designed and reported in accord with unified criteria, and the registration of acupuncture clinical trial should be valued, which could promote the integration of research results and improve the overall researches level. In this process, the research model of real world might be introduced to stimulate new development trends of acupuncture clinical research.

Acupuncture-Related Quality of Life Changes Using PROMIS Computer Adaptive Tests in a Pragmatic Trial with Oncology and General Integrative Medicine Patients: The Role of Baseline Acupuncture Expectations.

Acupuncture has been shown to alleviate symptoms and increase general well-being in different medical patient samples. A major challenge in acupuncture clinical research is the availability of comparable and standardized patient-reported outcome measurement (PRO) tools. This study used a pragmatic design to examine longitudinal changes in quality of life (QOL) in a medical patient sample following acupuncture using PROs from the National Institutes of Health's Patient Reported Outcomes Measurement Information System (PROMIS) initiative. It also examined the role of acupuncture expectancies, as well as patient and provider perceptions of acupuncture benefit. Following informed consent, patients completed baseline QOL measures (T1) prior to their first acupuncture session. Subsequent assessments (up to 20) were completed immediately following ensuing acupuncture sessions. Patients completed assessments either on a touch-screen computer at the clinic or from their home computer. Compared with acupuncture-naïve participants, those who received prior acupuncture treatment reported significantly higher anxiety, fatigue, sleep disturbance, and lower positive affect at baseline. By the second assessment, however, these differences became nonexistent. Participants who held greater baseline acupuncture expectations (e.g., their situation would improve a lot, they would have improved coping skills, their symptoms would disappear, their energy would increase) reported significantly higher fatigue, pain interference, and problems with physical functioning. Between T1 and T2, all participants reported significant improvements in anxiety, depression, and fatigue. Exploratory longitudinal models demonstrated significant linear improvements over time in anxiety (p = 0.006), depression (p = 0.007), pain interference (p < 0.001), and sleep disturbance (p = 0.004). No linear reduction over time was found with fatigue (p = 0.587), physical function (p = 0.654), or positive affect (p = 0.247). Overall, PROMIS computer adaptive tests were able to assess domains of QOL briefly. Although pretreatment acupuncture expectations highlighted subgroup differences in outcomes at baseline, linear-growth models demonstrated the positive effects of acupuncture over time on anxiety, depression, pain interference, and sleep disturbance.

Exploration of application of clinical research coordinator in acupuncture and moxibustion study

To explore the application of clinical research coordinator(CRC) in acupuncture and moxibustion study. The present application of CRC in many countries, such as America and Japan, was analyzed, and the critical actions of CRC were summarized. CRCs are crucial party of the clinical research coordinators group (CRCG).It aims to help regulate works among patients, sponsors and researchers with altruism. Now there are problems in clinical acupuncture and moxibustion research management, and the experience of CRC can enhance the efficiency and research level.

Dry needling: a de-meridian style of acupuncture

Recently, the educators of Dry Needling (DN) in the West often proclaime that DN is not acupuncture, and thus DN practitioners do not need to have the same training as acupuncturists. Their primary reason is that DN does not use the meridian theory of traditional Chinese medicine (TCM). In this paper, the authors refuted this claim. Through a systemic review on the global “Acupuncture Fever”, there are several different manifestations of “De-Meridian” phenomena (meridian theory is not required for acupuncture and other related modalities). Although De-Meridian has played a positive role in the development of acupuncture, it does not mean “De-Acupuncture” (modalities derived from but different from acupuncture). Given the clear definition of acupuncture by WHO, even though DN has certain attributes of De-Meridian that is similar to other forms of novel needling therapies, all of them belong to acupuncture. DN is a style of contemporary acupuncture, also called Trigger points (TrPs) acupuncture. This is because not only these myofascial TrPs stimulated by DN have always been acupoints, the needles and techniques used in DN are no different than acupuncture. Moreover, the mechanisms of DN and acupuncture are one in the same. The development of modern DN theory and its application are closely associated with the clinical trials and research of acupuncture. On the other hand, researches and clinical applications on myofascial TrP have highlighted the importance of stimulating reflex points in the clinic. However, as it refuses to inherit the theory and experience from thousands of years of acupuncture practice, it has shown obvious shortcomings in clinical applications.

A Mathematical Model for the Instigation and Transmission of Biological and Neural Signals in Response to Acupuncture

AbstractAcupuncture has been in clinical practice in China for thousands of years and its analgesia effect is worldwide accepted. However, the mechanism of acupuncture effect is not well understood. The study focus on signaling pathways induced by acupuncture, analyzes the cooperative action of the acupoints’ structure and the associated chemical mediators during acupuncture, establishes a mathematical model clarifying the roadmap of electroneurographic signal startup and transmission mechanism induced by acupuncture, quantitatively analyzing the response in acupoints to acupuncture. These work contribute to reveal the activation and transmission mechanism of neural signals induced by acupuncture from systems biology perspective, lay the foundation for the integration of acupuncture theory and modern science and further guide the clinical treatment and experimental research of acupuncture.

Review of Ethical and Scientific Aspects of Acupuncture Clinical Trials Pointed Out by Institutional Review Board a Part of Development Process of the Acupuncture and Moxibustion Clinical Research Guideline

Review of Ethical and Scientific Aspects of Acupuncture Clinical Trials Pointed Out by Institutional Review Board a Part of Development Process of the Acupuncture and Moxibustion Clinical Research Guideline

Discovery of Acupoints and Combinations with Potential to Treat Vascular Dementia: A Data Mining Analysis.

The prevalence of vascular dementia (VaD) is high among the elderly. Acupuncture, a popular therapeutic method in China, can improve memory, orientation, calculation, and self-managing ability in VaD patients. However, in clinical acupuncture and acupuncture research, the selection of acupoints to treat VaD remains challenging. This study aimed to discover acupoints and acupoint combinations with potential for VaD based on data mining. After database searching and screening for articles on clinical trials evaluating the effects of acupuncture on VaD, 238 acupuncture prescriptions were included for further analysis. Baihui (GV 20), Sishencong (EX-HN 1), Fengchi (GB 20), Shuigou (GV 26), and Shenting (GV 24) appeared most frequently in the modern literature and are potential acupoints for VaD. Combinations between Baihui (GV 20), Sishencong (EX-HN 1), Fengchi (GB 20), Shenting (GV 24), Shuigou (GV 26), and Zusanli (ST 36) were most frequent and represent potential combinations for VaD treatment. These results provide a reference for the selection and combination of acupoints to treat VaD in clinical acupuncture and acupuncture research.

Biophysical and clinical research on acupuncture and moxibustion.

Acupuncture has been used for thousands of years in treating diseases. Meridians and acupoints, on which acupuncture is practiced, have also attracted many research interests. Moxibustion is often used in conjunction with acupuncture as a thermal stimulation on acupoints. Laser, which generates extremely pure light of single wavelengths, is now used widely to stimulate acupoints, because it is noninvasive and easy to manipulate. This special issue contains 1 human research investigating the electrical characteristics of the acupoints, 2 randomized controlled trials (RCTs) evaluating the effect of traditional moxibustion on patients with knee osteoarthritis and lumber disc herniation, respectively, 3 animal studies exploring the effect and mechanism of the traditional moxibustion and laser moxibustion on irritable bowel syndrome (IBS), cyclophosphamide-induced leucopenia, and knee osteoarthritis (OA), respectively, 1 systematic review reviewing the safety of moxibustion, 1 paper describing the design of an electrical thermal stimulation system comparable to moxibustion, and 2 animal researches studying the effect and mechanism of electroacupuncture on disc degeneration and hepatic blood perfusion respectively. The results of these researches showed that acupoints may have special electrical characteristics at pathological status; moxibustion may relieve back pain and improve quality of life in patients with knee OA. Although the two RCTs did not report severe adverse events related to moxibustion, the systematic review found many factors may affect the safety of the moxibustion. The results of these researches also enhanced our knowledge of how traditional moxibustion, laser acupuncture-moxibustion, and electrical-acupuncture work in treating IBS, knee OA, cyclophosphamide-induced leucopenia, disc degeneration, and hepatic blood perfusion. The encouraging findings in this special issue will promote further investigations in the fields of biophysical and clinical research of acupuncture and moxibustion and may encourage more use of moxibustion in clinic. The electrical thermal moxibustion and laser moxibustion might be good substitutes for traditional moxibustion, because they produce thermal effect but with no chocking smoke and smell, thus being more suitable in modern medical environment. However, in this current special issue, researchers only investigated the effect of laser moxibustion on animal and introduced a design of electrical thermal moxibustion device; further clinical research on both moxibustion devices is needed in the future.

Historical and clinical perspectives on de qi: exposing limitations in the scientific study of de qi.

De qi is a concept most often associated with patient experiences during needling in acupuncture treatment. A review of the early historical literature on acupuncture shows that texts tended to describe de qi and its associated concept, qi zhi more in terms of practitioner-based phenomena and that this is something more in the realm of the experienced practitioner (i.e., it is skill based). Many modern authors in Asia and the West also describe the importance of practitioner-based experiences in the de qi of acupuncture, further implying that this may lie at the heart of the treatment effects of acupuncture. A review of scientific studies on de qi shows that qualitative studies have focused almost exclusively on patient-based aspects of de qi while quantitative studies have focused exclusively on them. There thus exists a gap in current research on the phenomenon of de qi that possibly reveals weakness in the wider study of acupuncture. It is important that precise qualitative studies of the practitioner-based aspects of de qi begin soon and as they become better understood, quantitative research also is initiated. This research will not only better inform clinical trials and physiologic research of acupuncture in general but could contribute significantly to rethinking of how to train practitioners.

Use of Acupuncture for Pain Management in An Academic Korean Medicine Hospital: A Retrospective Review of Electronic Medical Records

This study aimed to identify the descriptive characteristics of patients with pain conditions who visited an academic medical centre for traditional Korean medicine (TKM). This work was a retrospective review of the electronic medical records of patients who received at least one session of acupuncture for pain management from March 2010 to February 2012 in the Korean medical hospital of Pusan National University. Demographic characteristics and data on patient conditions, treatment interventions received and costs associated with acupuncture treatments were analysed. We identified a total of 2167 patients, including 2105 outpatients and 237 inpatients. The mean age (SD) of the patients was 52.0 (15.3) years, and approximately two-thirds of the patients were women (64.0%). The average number of acupuncture treatment sessions was 8.0 (6.6 for outpatients and 14.5 for inpatients). The most treated conditions were low back pain (30.5%), neck pain (23.9%) and shoulder pain (17.5%). Interventions included needle acupuncture with manual (52.6%) or electrical (47.4%) stimulation, herbal medicine (44.2%), cupping (21.2%) and moxibustion (3.5%). Over one-third of outpatients (33.5%) received at least six sessions of acupuncture. The median total cost of each outpatient and inpatient care per person was 169 604 and 1 001 707 Korean Won (approximately £98 and £577), respectively. Acupuncture was primarily used for the treatment of low back, neck and shoulder pain with a wide range of related interventions at an academic medical centre for traditional Korean medicine. These data reflect real clinical practice and should inform the design of future prospective clinical research of acupuncture.

Clinical efficacy observation of thalamic pain treated with acupuncture under the guidance of evidence-based medicine

ObjectiveTo study the feasibility of the crossover trial design and the minimal imbalance index random distribution method in the clinical small-sample-size randomized controlled trial (RCT) research of thalamic pain treated with acupuncture under the guidance of evidence-based medicine (EBM). MethodsThe crossover trial design was adopted. Eleven cases with the definite diagnosis were randomized into a program-I group (6 cases, treated with acupuncture before western medicine) and a program-ll group (5 cases, treated with western medicine before acupuncture) according to the minimal imbalance index method. In the statistical analysis, the groups were named as an acupuncture group and a western medicine group separately, 11 cases in each one. Acupuncture was applied to Xìmén (▪PC 4), Yīnxì (▪ HT 6), Xuèhăi (▪ SP 10), etc. In the control treatment, Carbamazepine was prescribed for oral administration. Either the duration of treatment or the wash-out period was 10 days. The visual analogue scale (VAS) was adopted for the efficacy assessment. ResultsThe total effective was 100.0% (11/11) after treatment in either group. The remarkably effective rates were 63.6% (7/11) and 36.4% (4/11) in the acupuncture group and the western medicine group separately, without statistically significant difference in comparison. ConclusionThe crossover trial design and the minimal imbalance index distribution method can accomplish RCT of the clinical acupuncture and moxibustion research with the small sample size involved. They can provide the high-quality evidences for clinical acupuncture research. Acupuncture therapy can achieve the same therapeutic effect as Carbamazepine, the common western medicine, and the efficacy of it is potentially superior to that of western medicine.

Qi, Acupuncture, and the Fascia: A Reconsideration of the Fundamental Principles of Acupuncture

Qi is a complex philosophical principle that may be applied to everything that exists. The qi principle, as has been commonly applied to acupuncture, is inconsistent with its application in other areas. This article considers the acupuncture concept of qi in light of recent research, particularly studies expanding the role of the fascia in human health. Qi is discussed in the context of philosophical, historical, and cross-cultural perspectives. The discussion includes the fascia acupuncture hypothesis, which suggests that fascial planes are the channels and the stimulation of the fascia results in activity of the tissue capable of affecting every aspect of physiology. Based on structural and functional parallels between the channel system and the fascia, such activity is hypothesized to be the qi of the channels, providing consistency to the application of the qi principle. Both acupuncture and "sham" acupuncture stimulate the fascia, perhaps contributing to the results of meta-analyses of clinical acupuncture research. Implications for future research and acupuncture education are discussed.

P02.86. A new method for quantifying the needling component of acupuncture treatments

Objectives The highly variable nature of acupuncture needling creates challenges to systematic research. The goal of this study was to test the feasibility of quantifying acupuncture needle manipulation using motion and force measurements. It was hypothesised that distinct needling styles and techniques would produce different needle motion and force patterns that could be quantifi ed and differentiated from each other. Methods A new needling sensor tool (Acusensor) was used to record needling in real time as performed by six New England School of Acupuncture staff from the ‘Chinese acupuncture’ (style 1) and ‘Japanese acupuncture’ (style 2) programmes (three from each). Each faculty expert needled 12 points (6 bilateral locations) in 12 healthy human subjects using tonifi cation (technique 1) and dispersal (technique 2). Parameters calculated from the raw needling data were displacement amplitude, displacement frequency, rotation amplitude, rotation frequency, force amplitude and torque amplitude. Results Data analysis revealed signifi cant differences in the amplitude of displacement and rotation between needling performed by staff from two different acupuncture styles. Signifi cant overall differences in the frequency of displacement between techniques 1 and 2 that were not dependent of the style of acupuncture being performed were also found. The relationships between displacement and rotation frequencies, as well as between displacement and force amplitudes showed considerable variability across individual acupuncturists and subjects. Conclusions Needling motion and force parameters can be quantifi ed in a treatment-like setting. Needling data can subsequently be analysed, providing an objective method for characterising needling in basic and clinical acupuncture research.

Complexity of acupuncture clinical research demonstrated by three well-known acupuncture clinical studies

Three discoveries in modern acupuncture,namely Kongzui(LU6) to treat hemorrhoids,needling from Yingxiang(LI20) through Sibai(ST2) to control the pain of biliary ascariasis,and needling from Tiaokou(ST38) through Chengshan(BL57) to relieve shoulder pain,have had a significant influence on acupuncture textbooks and acupuncture clinics during the past half century.The newly found conclusive evidence presented herein shows that these discoveries are completely incorrect or far from truly novel findings.This demonstrates the complexity of acupuncture clinical research,including research methodology challenges.We also identify the main problems of the design of acupuncture clinical trials,especially those published in famous international medical journals,and offer solutions to these problems.

Perspectives in clinical research of acupuncture on menopausal symptoms

Seventy percentage of perimenopausal and early postmenopausal women will experience menopause symptoms. Primary menopause symptoms in Western countries included hot flashes, insomnia, somatic pain, depression, and fatigue. Hot flashes were most commonly treated. Menopausal hormone replacement therapy (HRT) continues to have a clinical role in the management of vasomotor symptoms, but since 2002 there has been a marked global decline in its use due to concerns about the risks and benefits of HRT; consequently many women with menopause symptoms are now seeking alternatives including acupuncture. Acupuncture has a long tradition of use for the treatment of different menopause symptoms. Its effectiveness has been studied for natural menopause or chemical and surgery induced menopause. Here we provide an update on recent advances in the field for clinicians. The recent systematic reviews on acupuncture in menopausal symptoms suggest that acupuncture is an effective and valuable option for women suffering from menopause. However, the science of acupuncture therapies is still inadequate to sufficiently support the benefits of acupuncture therapies. Finally, we discuss our points of view on clinical trials of acupuncture for menopause symptoms.

Clinical Research of Acupuncture on Malignant Tumor Patients for Improving Depression and Sleep Quality

To study the effect of acupuncture on depression and insomnia of malignant tumor patients. Eighty cases of cancer related depression and sleep disorders were randomly divided into 2 groups: treatment 1 group (acupuncture n = 40) and control group (Fluoxetione n = 40). All patients were assessed by Self-rating Depression Scale (SDS), Hemilton Depression Rating Scale (HAMD) and Pittsburgh Sleep Quality Index (PSQI) after treatment for 30 days. Before treatment the SDS and HAMD scores of the trial group were 64.12 +/- 5.34 and 20.92 +/- 2.38, those of the control group were 64.24 +/- 4.98 and 20.72 +/- 2.74, after treatment the SDS and HAMD scores of the trial group were 43.64 +/- 5.28 and 9.88 +/- 1.27 respectively, significantly lower than those of the control group (50.76 +/- 5.42 and 13.72 +/- 2.05 respectively, both P < 0.05). Before treatment the PSQI score of the trial group and the control group were 14.48 +/- 1.71 and 13.92 +/- 2.59, after treatment the PSQI score of the trial group was 7.92 +/- 1.22 after treatment, significantly lower than those of the control group (11.44 +/- 1.89, P < 0.01). Acupuncture can effectively reduce malignant-related depression, improve sleep quality, and help to improve the quality of life of cancer patients.

Clinical acupuncture research in the West

In recent years, acupuncture has rapidly become part of mainstream medicine in the West, where new developments in acupuncture clinical research show extensive progress in evaluating the efficacy and safety of the modality in many categories of disease, especially in pain conditions. Although challenges and difficulties remain, the acupuncture research community has matured and its past experience may lead to even better methods and more innovative research.

Issues of design and statistical analysis in controlled clinical acupuncture trials: an analysis of English‐language reports from Western journals

To investigate major methods of design and statistical analysis in controlled clinical acupuncture trials published in the West during the past six years (2003-2009) and, based on this analysis, to provide recommendations that address methodological issues and challenges in clinical acupuncture research. PubMed was searched for acupuncture RCTs published in Western journals in English between 2003 and 2009. The keyword used was acupuncture. One hundred and eight qualified reports of acupuncture trials that included more than 30 symptoms/conditions were identified, analyzed, and grouped into efficacy (explanatory), effectiveness (pragmatically beneficial), and other (unspecified) studies. All were randomized controlled clinical trials (RCTs). In spite of significant improvement in the quality of acupuncture RCTs in the last 30 years, these reports show that some methodological issues and shortcomings in design and analysis remain. Moreover, the quality of the efficacy studies was not superior to that of the other types of studies. Research design and reporting problems include unclear patient criteria and inadequate practitioner eligibility, inadequate randomization, and blinding, deficiencies in the selection of controls, and improper outcome measurements. The problems in statistical analysis included insufficient sample sizes and power calculations, inadequate handling of missing data and multiple comparisons, and inefficient methods for dealing with repeated measure and cluster data, baseline value adjustment, and confounding issues. Despite recent advancements in acupuncture research, acupuncture RCTs can be improved, and more rigorous research methods should be carefully considered.

First Sino-German International Symposium on acupuncture and moxibustion

In July 2009, the first Sino-German symposium on acupuncture and moxibustion took place in Chengdu. With the title “future of acupuncture clinical research and integration of acupuncture treatment into health care” the symposium aimed to stimulate the dialogue between East and West. The following article will provide some insights into the topics of the symposium.