针灸治疗原发性三叉神经痛临床疗效观察

目的:通过本研究探讨原发性三叉神经痛采用针灸治疗的临床疗效。方法:研究资料选取自中国水利水电第四工程局有限公司西宁中心医院2008年6月至今收治的38例原发性三叉神经痛患者,将入选对象按照数字分组法分为两组(每组各19例)。对照组给予常规西药治疗,观察组给予中医针灸治疗,比较两组治疗效果。结果:观察组患者的临床疗效(89.5%)与对照组(73.7%)之间存在明显差异性(P0.05)。结论:原发性三叉神经痛患者经针灸治疗后疗效满意,是治疗原发性三叉神经痛的首选方案。     

实用性临床试验在中医疗效评价中的应用

循证医学提出后,寻找并产生合适的证据成为中医疗效评价的关键。随机对照试验(RCT)是目前公认的医学干预评价的金标准,但传统随机对照试验(解释性临床试验,ECT)并不适合中医个性化治疗的特点。中医学理论形成和发展基于大量临床经验,评价其临床效果和安全性是首要任务。由于中医治疗措施的复杂性和个体化,中医疗效所体现的是一个受到环境影响的复杂体系。实用性临床试验(PCT)的特点正适合于中医药这种复杂医疗干预体系的评价。本文将讨论PCT在中医疗效评价中的可行性,探索一种中医疗效评价的新思路。     

针灸合并天麻钩藤饮治疗高血压Meta分析

[目的]评价针灸联合天麻钩藤饮治疗高血压的临床疗效。[方法]通过计算机检索PubM ed、Embase、The Cochrane Library、CNKI、VIP、Wanfang Data、以及CBM数据库,收集有关针灸联合天麻钩藤饮治疗高血压的随机对照试验(randomized controlled trial,RCT),检索时间均为建库至2018年11月26日。采用RevM an5. 3软件进行Meta分析。[结果]最终纳入7个RCT,共722例研究。Meta分析结果显示,治疗组总有效率优于对照组[OR=5. 39,95%CI(2. 97,9. 80),(P <0. 000 01)])。[结论]针灸联合天麻钩藤饮治疗高血压有良好的疗效,但现有研究数量少、质量低且针灸方式不利于盲法的进行,需要设计规范化、高质量、高标准、大样本的随机对照临床试验为高血压的临床治疗提供真实可靠的证据。     

针灸临床随机对照试验的设计特点与方法

虽然针灸以其卓越的临床疗效受到国内外学者的广泛关注，并且已有大量临床研究发表，但从总体来说针灸临床研究仍存在研究质量偏低的问题。结合循证医学的思想，介绍针灸临床研究方案及其循证医学证据级别，并分析目前国外针灸临床研究常见设计。因临床随机对照试验（RCT）是防治性研究最重要的研究方案，故针对针灸RCT的随机分配、分配隐藏、设盲、对照及质量控制等特点进行论述，着重阐述目前针灸RCT存在的问题及解决办法，并通过提供针灸预防性治疗偏头痛的RCT实例，对针灸RCT设计及实施提出建议，以期提高国内针灸临床研究水平。     

针灸治疗高血压病临床研究概况

从针灸治疗方法方面,对近10年来针灸用于高血压病的临床研究进行综述,经临床试验及科研研究,单纯针刺及针刺与其他方法相结合在临床治疗高血压方面疗效确切。通过综述,提出目前针灸治疗高血压病临床研究亟待解决的问题并对其今后研究进行展望。     

针灸临床随机对照试验的设计特点与方法

虽然针灸以其卓越的临床疗效受到国内外学者的广泛关注,并且已有大量临床研究发表,但从总体来说针灸临床研究仍存在研究质量偏低的问题.结合循证医学的思想,介绍针灸临床研究方案及其循证医学证据级别,并分析目前国外针灸临床研究常见设计.因临床随机对照试验(RCT)是防治性研究最重要的研究方案,故针对针灸RCT的随机分配、分配隐藏、设盲、对照及质量控制等特点进行论述,着重阐述目前针灸RCT存在的问题及解决办法,并通过提供针灸预防性治疗偏头痛的RcT实例,对针灸RCT设计及实施提出建议,以期提高国内针灸临床研究水平.     

循证医学与针灸疗效评价荟萃

背景：针灸作为有着自己独特理论指导的古老治疗手段已广泛运用于多种疾病的防治中，但是就其对某些疾病的疗效目前还有较大争论。而对临床疗效评价的最佳研究是公认的临床随机对照试验（RCT），故笔者对国内近年来所发表的关于针灸疗效评价的文章进行了归纳研究。目的：通过近年来所发表的有关防治性临床随机对照试验评价，了解目前临床科研设计的方法学现状。方法：按照EBM标准，对近年来所发表的关于针灸疗效评价文章进行检索及归纳，并评价RCTs研究的质量。结果：关于疾病评价的文章15篇，共评价12种疾病。关于期刊评价的文章5篇，评价的期刊为《中国针灸》、《上海针灸》、《针灸临床杂志》。结论：严格开展RCT的临床试验太少，若要提高针灸的学术地位，必须加强中医决策机构的宏观调控。     

针灸组方治疗原发性高血压临床研究

目的：观察针灸组方对原发性高血压的治疗作用。方法：将符合原发性高血压诊断标准的60例患者随机分为常规针刺组、药物治疗组和针灸组方针刺组,7日为一个疗程,3个疗程后观察疗效。于治疗前及治疗间期测定血压进行评定。结果：临床疗效总有效率常规针刺组71.37%,药物治疗组80.29%,针灸组方针刺组79.31%,经统计学分析,针灸组方针刺组和药物治疗组疗效相当,且优于常规针刺组。各组治疗前后血压比均存在显著性差异（P（0.05）。结论：针灸组方治疗原发性高血压在临床治疗方面存在较好的疗效。     

耳穴疗法联合针灸治疗老年原发性高血压疗效观察

目的:探讨联合中医耳穴疗法与针灸技术治疗老年原发性高血压的临床疗效。方法:选取解放军第273医院2016年1月至2016年12月收治的老年原发性高血压患者90例,回顾性分析其临床资料,按照治疗方式分组,对照组(n=43)采用常规西药治疗,观察组(n=47)基于对照组加用中医耳穴疗法联合针灸治疗,比较两组患者临床疗效。结果:观察组患者总有效率91.5%,明显高于对照组72.1%,组间比较,差异具有统计学意义(P0.05);两组患者治疗前收缩压(SBP)、舒张压(DBP)比较,差异无统计学意义(P0.05),治疗后观察组血压明显低于对照组,差异具有统计学意义(P0.05)。结论:联合中医耳穴疗法与针灸技术治疗老年原发性高血压临床疗效优良,可明显降低血压。     

针灸治疗原发性肝癌疼痛的临床研究进展

经查阅近20年(1996年—2016年)所有针灸治疗原发性肝癌疼痛的临床文献,发现其具有镇痛疗效好、无依赖性、不良反应低的优点,本研究将从本病的中医病因病机、中医辨证分型、针灸取穴处方、针灸治疗手段等4个方面来探讨针灸治疗本病的疗效和机制,旨在分析总结思路和方法得以更好地指导临床。     

针刺治疗呃逆疗效的系统评价

目的：系统评价针刺在治疗呃逆中的疗效,为针刺在呃逆治疗中的应用提供依据。方法：检索针刺治疗呃逆的随机对照试验研究的文献,对其进行Meta分析。结果：共纳入包括547名受试者在内的随机对照试验8个,Jadad评分2个2分,6个为1分,且所有研究均处于C级,质量不高。针刺疗法与非针刺疗法相比,总体疗效合并OR=10.45,95%CI[6.28-17.39];漏斗图显示研究存在一定的发表偏倚。结论：现有临床研究证据表明针刺疗法在治疗呃逆存在一定的优势,未见明显不良反应的报道,但由于纳入研究数量有限,且质量不高,影响了本次评价的效度,中医临床科研的质量有待提高。     

FACTORS THAT MAY CONTRIBUTE TO THE INSTANT ANALGESIC EFFECTS OF ACUPUNCTURE FOR PRIMARY DYSMENORRHEA IN CLINICAL RANDOMIZED TRIALS

Objective: There are a great many variables in acupuncture treatment(e.g., point selection, the number of points selected, Chinese medicine patterns, acupuncture manipulation, different intervention time of acupuncture, duration of needling, number and frequency of sessions and needling sensation), all of which need to be addressed in designing and reporting clinical trials.We aim to find the factors that may affect the instant analgesic effects of acupuncture on primary dysmenorrhea in randomized controlled trials(RCTs).Methods: We reviewed factors involved in RCTs in three systematic reviews about acupuncture for primary dysmenorrhea.Results: The overall findings of this literature review suggested that the durations of needling in most RCTs lasted for 20-40 min, and the number and frequency of sessions were likely to last for 5-7 d and continued for three sessions.However, those variables of stimulation including point selection, number of points used, Chinese medicine pattern, acupuncture manipulation and different intervention time of acupuncture were particularly diverse from each other in treatment for primary dysmenorrhea.Conclusion: Our findings reinforce the understanding of acupuncture as a complex intervention.To identify how each component contributes to the instant analgesic effect, well-designed trials comparing those interventions head to head would be a practical and realistic approach to establish optimally effective acupuncture for primary dysmenorrhea.Few rigorous studies have compared the relative efficacy of different acupuncture treatment components within their protocols.Conclusive agreement on those parameters supporting the optimal treatment for patients has not been achieved.Due to the poor quality of available evidence shown in current statues, controlled comparative studies looking at every relevant variable of treatment for primary dysmenorrhea ought to be paid more attention, which may help clinical trials to improve transparency and standardize treatment efficacy.     

RANDOMIZED CLINICAL TRIALS ON ACUPUNCTURE PUBLISHED IN CHINESE JOURNALS:A SYSTEMATIC LITERATURE REVIEW

Objective: To systematically evaluate the number and quality of randomized clinical trials(RCTs) on acupuncture published in Chinese journals.Methods: We systematically searched the four main electronic Chinese databases(CNKI, VIP, CBM, Wanfang) from their inception in January 2013 to identify RCTs on acupuncture(including manual and electronic acupuncture), to bibliometrically analyze the RCTs, and to assess methodological quality of the RCTs.Results: A total of 7085 RCTs(involving 698540 participants) were published from 1982 to 2013 in Chinese literature.The top three disease systems identified in the included trials were nervous system(39.5%), musculoskeletal system and connective tissue(21.3%), and genitourinary system(6.2%) according to ICD-10.The 7085 acupuncture trials were compared with no treatment(51 trials, 0.7%), sham-acupuncture(62 trials, 0.9%), conventional treatment(728 trials, 10.3%), other traditionalChinese medicine(911 trials, 12.9%), as well as acupuncture plus conventional treatment versus conventional treatment(946 trials, 13.4%), acupuncture plus one treatment versus another treatment(1493 trials, 21.7%), acupuncture plus one treatment versus acupuncture alone(915 trials, 12.9%).In addition, 1135 trials(16.0%) were two-armed RCTs, in which acupuncture applied in both groups.A total of 844 trials(11.9%) were three or more-armed RCTs.Forty-two trials(0.6%) of 7085 RCTs clearly defined primary and secondary outcomes, 6803(96.0%) reported clinical relevant outcomes, 659(9.3%) reported surrogate outcomes, 497(7.0%) reported safety outcomes.For methodological quality, 2658(37.5%) RCTs reported randomization methods, 121(1.7%) reported allocation concealment methods, 141(2.0%) applied blinding, and only 28(0.4%) described sample size calculation.Conclusion: The number of RCTs on acupuncture was substantial and increasing in China, and acupuncture was most frequently applied to nervous, musculoskeletal and connective tissue diseases.However, the methodological quality of the trials is still low.We recommend that the reports of future RCTs on acupuncture will be based on CONSORT and STRCTA.     

建立信息化的中医和针灸临床研究:孟德尔遗传定律的发现过程给我们的启示

中医和针灸理论是中国古人在观察人的基本生理病理机制和治疗人类疾病的实践中提炼出的朴素的医学理论,它是在中国古代哲学和原始的医学实践相融合的基础上而形成的。现代针灸研究表明,古老的中医针灸理论中积累了许多经得起现代医学检验的临床实践。近年来,现代生物信息学把现代生物医学推向了基因组和后基因组的时代;计算机在生物学中的应用,大大地拓展了生物医学研究的深度和广度;一系列以数学模式和统计学为基础的、新的数据分析方法,使现代生物医学的亮点从分析局部效应走向系统整合,提高了科学研究结果在临床实际中的应用性和可重复性。这些新的生物信息学方法,可以帮助中医针灸在保持其特色的前提下,引入新的以数学为基础的数据分析方法,扩大临床研究样本的积累,提高研究效率和数据整合。     

中医药辨治高血压的认识与发展＊

高血压属中医“眩晕”“头痛”等范畴，多为本虚标实证，其死亡率、致残率较高，在所有心脑血管疾病危险因素中居于首位，是人类健康的“无形杀手”。中医认为风、痰、虚、瘀等病邪侵袭人体导致肝、脾、肾三脏功能失调是高血压发病的主要机制，主要证型可分为肝阳上亢、痰湿中阻、瘀血阻窍、气血亏虚、肾精不足等，治疗以平肝潜阳、健脾化痰、活血化瘀、益气养血、补肾填精为主。本文从中药组方、针灸、穴位贴敷、足浴等方面总结了中医药和中西医结合治疗高血压的进展，建议根据高血压的分级情况确定单独使用一种疗法或中西医结合治疗，对于症状严重且影响生活质量的高血压患者建议辅以针灸和穴位贴敷等。为了更好地发挥中医药治疗高血压的优势与特色，今后需进一步开展大样本量、长期性、系统性的临床研究，并发展个体化精准治疗和智能医疗。     

针灸治疗轻、中度原发性高血压随机对照试验的Meta分析

目的:采用Meta分析系统评价针灸与西药治疗轻、中度原发性高血压的临床疗效和安全性差异。方法:全面检索针灸与西药比较治疗轻、中度原发性高血压的随机对照试验文献,选择合格研究并进行质量评价,采用RevMan5.1软件进行meta分析。结果:共纳入10个随机对照试验包括782例患者。Meta分析结果:①降压疗效:单用针灸与单用西药比较,2组降压疗效无明显差异;针灸+西药与单用西药比较,针灸+西药组明显优于单用西药组;②症状疗效:单用针灸或针灸+西药均优于单用西药,纳入试验中未见不良反应报道。结论:针灸治疗轻、中度原发性高血压安全有效。但本研究纳入试验数有限且多数文献质量较低,需设计更严格的随机对照试验来进一步验证上述结论。     

High-intensity Laser for Laser Acupuncture Application

Objectives: The purpose of this study is to review laser acupuncture studies to investigate the possibility for applying high-intensity lasers to acupuncture and moxibustion treatment.Methods: Papers were searched using the search engines of five electronic databases, including Pubmed, Thomson ISI, EMBASE, ScienceDirect, and EBSCO, from inception to May 2011 without language limitation. Inclusion criteria were clinical studies with humans, randomized controlled trials (RCTs), case-control studies, and case reports. Papers were selected based on title and abstract in the first step, the full text was scrutinized in the second step, and then the extracted data were analyzed by two authors independently. The methodological quality for RCTs was evaluated using Jadad's scale.Results: A total of 8 papers (3 RCTs, 5 controlled studies, and 1 case report) were finally selected. One paper each addressed surgical argon and CO2 lasers, two addressed GaAs lasers and four addressed new GaN semiconductor lasers. The output range was from 110 mW to 15 W. The diseases studied were alcohol addiction, knee osteoarthritis, bronchopneumonia and asthma for children, and circulation. All studies reported positive effects. The methodological quality in all RCTs was low, below 3 points, and all studies had few subjects.Conclusions: We suggest that high-intensity lasers can be applied to acupuncture and moxibustion. Further rigorous and well-designed studies will be needed for various diseases. The Oriental Medical Society needs to take active measures to study the clinical applications of high-intensity lasers to acupuncture and moxibustion treatment.Key Words: laser; laser acupuncture; high-intensity laser; high level laser     

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.     

针灸治疗慢性疲劳综合征文献质量评价

目的对针灸治疗慢性疲劳综合征的临床研究文献进行质量评价。方法检索1998—2008年针灸治疗慢性疲劳综合征的临床研究文献。按照临床流行病学和循证医学的原则和方法,对临床研究类型及方法学,一般情况,疾病诊断及纳入、排除标准,样本含量,疗效判定标准,随访,不良反应及安全性等进行评价。结果在78篇纳入文献中,国内研究76篇,且均发表于国内出版的中文期刊,仅有的2篇英文发表于国内出版的英文期刊;真正随机对照试验仅7篇,半随机对照试验及联系不到作者的随机对照试验21篇,非随机对照试验3篇,叙述性研究47篇;采用国际公认诊断标准的50篇,提及纳入、排除标准的22篇;采用中医疗效标准的26篇,用评分法进行疗效判定的研究有27篇;样本量100例以上的4篇,60～99例33篇;进行依从性评价的4篇;有退出、脱落病例记录及描述的3篇;记录随访情况的2篇;进行不良反应记录的11篇。结论针灸治疗慢性疲劳综合征的临床研究主要集中在国内,且研究质量和文献总体水平相对较低,这一领域迫切需要设计严谨的高质量随机对照研究,同时研究者应积极向国外期刊投稿。     

循证医学在建立中医卒中单元中的应用

目的探讨用循证医学的理念建立中医卒中单元,为我国脑卒中的临床治疗服务。方法以中医基础理论为依据,参照经循证医学肯定疗效的卒中单元模式,建立以针灸为其特色的中医卒中单元。结论建立有中医特色的中医卒中单元是今后努力的方向,但仍需高质量的临床证据。