Westliche und TCM-diagnostische Kriterien der Menopause bei deutschen und chinesischen Frauen: Eine transkulturelle multizentrische Vergleichsstudie

Background

The following study follows a comparative cross-cultural multicenter trial design concerning menopausal conditions in patients from Germany and China.

Methods

Each of the 35 patients suffering from menopausal symptoms recruited out of the Institute of Complementary and Traditional Chinese Medicine, Knappschafts-Kranhenhaus, Kliniken Essen-Mitte, Germany, and from the Shugang Hospital in Shanghai, China, were examined using the Kupperman-index and a standardised TCM-questionnaire. In addition Estrogen and Testosterone parameters were collected from each patient. Means were compared using Students t-test, frequency distributions were compared using Pearson Chi-Square.

Results

The mean value of cumulative symptoms as recorded with the Kupperman-Index showed no significant difference between German and Chinese women. However, the examination of single items revealed statistically significant differences between the two groups examined. The Kupperman-Index focuses on psychological parameters in contrast to the TCM-questionnaire. On the other hand, the TCM-questionnaire examines single items and often diagnosed a “Kidney-Yin-Deficiency” (74.3 %) in Chinese women, whereas German women more often showed a “Kidney-Yang-Deficiency” (51.4 %). The Chinese exhibited significant higher levels of Testosterone, levels of Estrogen were not significantly different.

Conclusions

A combination of Western Kupperman-index and TCM-questionnaire promises a more symptom-orientated classification of menopausal women in subgroups with corresponding integrative therapeutic options. A possible classification of hormone levels with respect to ethnical or TCM-subgroups might be examined in subsequent studies by the means of larger study groups and more equally distributed group patterns.     

Akupunktur bei Patienten mit allergischer Rhinitis: Analyse der Studienintervention und Syndrommuster der randomisierten Multicenter Studie (ACUSAR)

Background

Acupuncture was efficient and superior to sham acupuncture and a control group in the ACUpuncture in Seasonal Allergic Rhinitis (ACUSAR) trial. The article aims to inform about the study intervention, the underlying therapeutic ideas and clinical consequences.

Design

Three-armed, randomized, controlled multi-center-trial with a 16-week follow-up during the SAR season in the first trial year and an 8 week follow-up during the SAR season in the following year.

Setting

Outpatient or private clinics in Germany.

Intervention

422 Patients with seasonal allergic rhinitis on birch and grass pollen have been randomized to fall into 3 groups: 12 sessions of semi-standardised acupuncture plus rescue medication (RM, Cetirizine) or 12 sessions of sham acupuncture plus RM or RM alone during the initial two months of the study. Study intervention was defined in a Delphi consensus procedure including five experts from two major German acupuncture associations and three experts on trial methodology and statistics. A consensus between the need for standardisation and individualisation was defined using a semi-standardised treatment in the acupuncture group: 4 obligatory acupuncture points, ≥ 3 out of 8 facultative basic points and ≥ 3 facultative local or distant acupuncture points. Sham acupuncture consisted in superficial needling of at least 5 of 7 predefined, bilateral, distant non-acupuncture points. Needling characteristics such as point location, needling time, manipulation and achieved ‘De Qi' had to be documented after each session.

Results

CM syndrome diagnoss reported most frequently were Wind-Cold invading the lung' and ‘Wind-Heat invading the lung' (37 % each). In the acupuncture group all basic obligatory points were used in 97 % of cases (LI 4, LI 11, LI 20, EX-HN 3 Yintang). The most frequently used basic optional acupuncture points were GB 20, LIV 3, ST 36, LU 7 and SP 6. The total number of needles used was higher in the acupuncture group (15.7 ± 2.5) compared to the sham acupuncture group (10.0 ± 1.6).

Conclusions

CM syndrome diagnoses and point selection in the acupuncture group of the trial corresponded to clinical experiences in CM treatment of SAR. Point location and a higher number of needles in the acupuncture group compared to the sham acupuncture group may have influenced the positive trial results.     

Einfluss der Akupunktur auf den Augendruck und die Compliance bei Patienten mit okulärer Hypertension oder primärem Offenwinkelglaukom: Erste Ergebnisse einer prospektiven kontrollierten Langzeitbeobachtung

Background and Aims

Primary wide-angle glaucoma (the most common form of glaucoma) is a multi-factorial disease of the optic nerve marked by the preceding loss of retinal ganglion cells, eventually leading to the atrophy of the optic nerve. Intraocular pressure (IOP) makes up the most important and most treatable risk factor.

Methods

The study examined the effect of acupuncture therapy on eye pressure and the compliance in patients suffering from primary wide-angle glaucoma (n = 21) and ocular hypertension (n = 13) against a group of test subjects not suffering from any eye complaint (n = 16). Before commencing therapy, corneal thickness was determined by 4Optics-Pachymeter. Before and after acupuncture treatment, an ophthalmologic determination of visual acuity according to DIN 58220 and a computer-aided visual field analysis were done. The IOP was measured before and immediately after acupuncture as well as 30 minutes after therapy. Changes in compliance were documented with a standardized questionnaire completed by each patient having received this treatment.

Results

It was shown that for patients with primary wide-angle glaucoma and ocular hypertension, acupuncture is able to significantly lower intraocular pressure. According to the questionnaire analysis, a subjective improvement of quality of life and better compliance of using anti-glaucomatous medication was achieved.

Conclusions

Acupuncture is an appropriate method to treat patients with primary wide-angle glaucoma in addition to lowering eye pressure by anti-glaucomatous pharmacological therapy. In patients suffering from ocular hypertension, acupuncture can significantly lower intraocular pressure and therefore reduce the rate of conversion into a manifest glaucoma. Therefore this treatment can be suggested for ocular hypertension patients with contraindications against local anti-glaucomatous medicine (e. g. beta-blocker). However, it is absolutely necessary in this treatment that patients are continuously monitored regarding visual field, retinal nerve fibre thickness and micro-morphological alterations of the disc in order to detect tissue damage of the optic nerve and functional loss caused by the onset of glaucoma.