《针灸临床实践指南》制定的方法学与推广初见

针灸在国际上日益受到人们关注,但是对于现代医学来说却是一种"尚没有科学依据的"补充替代疗法,因此《针灸临床实践指南》的制定具有重要意义。《针灸临床实践指南》的制定方法在借鉴国内外现代医学临床实践指南基础上,除了重视临床实践指南制定的目的和意义、指南小组的组成、文献质量的评价、推荐强度的分级、指南的回顾与更新、指南的推广等方面外,还要充分体现针灸学科的自身要求和特色。     

试述针灸临床实践指南的特点

为进一步推进针灸现代化和国际化进程,遵循最佳临床证据,参考国际指南制定的一般模式的同时,制定有特色的针灸临床实践指南,运用专家共识、问卷调查等方法,结合针灸临床特点和需求,制定能充分体现针灸学科特色——适用性、传承性、整体观、学科特点的针灸临床实践指南,从而达到规范针灸医疗行为,加强针灸医疗服务质量管理,控制针灸医疗费用,推进针灸现代化和国际化进程的最终目的。     

现有系统评价在临床实践指南制定中的作用初探

目的:以针灸治疗失眠为例,探讨现有系统评价在临床实践指南制定中的指导意义和存在的问题。方法:全面检索并详细阅读相关中英文系统评价文章共15篇,分析其基本信息,重点结合临床实践指南具体的制定过程,研究此类型文献对指南可能产生的指导意义和因其本身存在问题而在再利用时需要注意的事项。结果:系统评价文献在适用人群、推荐诊断和疗效评价标准、扩展推荐内容以及方法学方面对指南的制定有较重要的指导意义,而在直接应用其研究结果、解读评价结果等方面仍需谨慎,必要时需做数据的重新核对。结论:系统评价文献对于指南的指导作用是重要的,但想要最大限度应用其中的信息,还需结合研究目标具体分析。     

国内外针灸临床实践指南的现状调查与内容分析

调查国内外针灸临床实践指南制定现状,为当前国际针灸临床实践指南的制定提出方向性建议。采用问卷调查、数据库检索、专家咨询的形式获取针灸临床实践指南,仔细阅读全文,并对内容进行分析。检索到相关针灸临床实践指南27部,其中中国针灸临床实践指南数量最多。各国指南中对"针灸"的定义范围不同,指南内容的侧重点和制定方法差异较大,有必要对指南制定方法进行统一;古籍文献作为证据是中国针灸临床实践指南的特色,挖掘针灸古代文献价值和针灸大家的临床经验,是以后针灸临床实践指南制定的关键点和难点。     

“针灸临床实践指南”的特点及制定的原则与方法探讨

分析了"针灸临床实践指南"所具有的鲜明学科特色,指出了其制定所必须遵循的一般原则,讨论了"指南"制定的主要方法,为"针灸临床实践指南"的制定提供了重要的启示.     

循证医学快速评价方法在中医临床实践指南制定中的应用

目前中医循证临床实践指南的制定面临着文献量巨大、投入不足等诸多问题。快速评价作为一种证据综合方法,以其"迅速"的优势在循证临床实践指南的制定中发挥着重要作用。基于国内外相关快速评价的研究,对快速评价方法在中医循证临床实践指南制定中的适用情况进行探讨,以期对中医循证临床实践指南制定方法提供新的线索和依据。     

针灸治疗神经根型颈椎病临床实践指南（英文）

在全面搜集相关文献证据基础上,按照证据质量与推荐强度分级系统(GRADE)方法,制定了《神经根型颈椎病针灸临床实践指南》,具体介绍了指南制定的目的、指南适用的疾病范围、针灸治疗神经根型颈椎病的原则、干预时机及不同针灸治疗方案等。     

针灸临床实践指南制订中证据体的评估方法探索——分层证据评分法

研究适用于针灸临床实践指南制订中证据体的评估方法,为针灸临床实践指南的制订提供方法学支持,推动针灸标准的制订与应用。根据中医针灸学的学科特点,提出"分层证据评分法",首先从古代文献、现代文献、现代名医经验等方面多角度收集证据,并客观科学地辨别证据、评价证据,再通过层次分析法将证据集合形成证据体,最终根据综合评分指数的高低举荐针灸方案。基于"分层证据评分法"形成的针灸实践指南推荐方案,证据更加全面充分,使针灸临床实践指南推荐方案更具有科学性、客观性。     

《偏头痛针灸临床实践指南》编制特点与临床应用

对照国外制定的《偏头痛循证指南》,分析了世界卫生组织西太区《偏头痛针灸临床实践指南》的编制特点,并对本指南的适用范围、临床应用价值及注意事项进行了简要的说明。对本指南编制的方法学特点从4个方面进行阐述:纳入文献的一般情况、文献质量评定标准、证据级别分级标准、推荐意见强度分级标准;对推荐方案的特点则从普适性、分类方法及内容3个方面进行了分析阐述。     

针灸临床研究若干问题探讨

针对当前针灸临床研究现状,分析了国内外临床研究存在的问题及原因,提出了针灸临床研究应以提高临床疗效、服务于临床为目的.临床研究方法要借助于循证医学方法但不能机械照搬,认为针灸的“理、法、穴、术”的完整运用才能保证针灸的临床疗效.应建立起针灸临床优势病种的临床实践指南及临床路径,同时加强针灸特色疗法的机理及临床研究,以提高临床疗效.     

《针灸临床实践指南》国际需求的调查:一项横断面研究

ObjectiveThis study aims to get the medical management of acupuncture and moxibustion in the countries and regions where the society members of World Federation of Acupuncture-Moxibustion Societies (WFAS) are located, including the educational background of acupuncture and moxibustion practitioners and the local clinical practice of acupuncture and moxibustion, and the demands of the content and evidence types of Clinical Practice Guidelines (CPGs) of acupuncture and moxibustion in accordance with WFAS standards, so as to provide requirements and reference principles for the development of CPGs of acupuncture and moxibustion in accordance with WFAS standards.MethodsThe convenient sampling method was used to collect the questionnaires, and the WFAS secretariat distributed the questionnaires to 294 contacts of society members from 70 countries and regions in the form of Questionnaire Star four times in April 2020, July 2020, March 2021, and April 2021 respectively. They were then distributed to individual members of acupuncture-moxibustion societies by the contacts. The study content involved the basic information of respondents, including their nationality, occupation, educational background of acupuncture and moxibustion, their local clinical practice and medical management of acupuncture and moxibustion, as well as their demand for CPGs of acupuncture and moxibustion, etc. After the questionnaires were collected, the data were analyzed and described by quantitative research method.ResultsIn all, 302 respondents from 37 countries of six continents responded. The 302 respondents were members of the WFAS society members. (1) Basic information of respondents. They all had acupuncture and moxibustion learning experience, among which, 76.5% (231/302) had the education background of acupuncture and moxibustion professional college training, and 88.4% (267/302) had experience of acupuncture and moxibustion clinical practice. Acupuncturists or traditional Chinese medicine doctors accounted for 63.9% (193/302), western medicine doctors, nurses, and pharmacists accounted for 18.2% (55/302), and researchers and teachers accounted for 6.3% (19/302). (2) Local clinical practice and medical management of acupuncture and moxibustion. The level of clinical practice of acupuncture and moxibustion varies greatly among the regions where the WFAS society members lived. Among them, more countries in Europe have not included acupuncture and moxibustion in medical insurance than those in other continents (x²=26.049, P < 0.01), and more countries have not included acupuncture and moxibustion in public hospital treatment system than those in other continents (x²=113.488, P < 0.01). (3) Demand for CPGs of acupuncture and moxibustion. A total of 93.0% (281/302) respondents believed that WFAS CPGs of acupuncture and moxibustion would be helpful for their local practice. The order of their demand and concern for WFAS CPGs was: acupuncture manipulation > latest progress of acupuncture treatment > choice of acupuncture therapies > safety of acupuncture and moxibustion > combination of acupuncture and other programs. A total of 87.4% (264/302) respondents believed that ancient classics could guide clinical practice, and the ancient literature should be used as evidence for the development of guidelines.ConclusionThe respondents are those future practitioners of CPGs of acupuncture and moxibustion conforming to WFAS standards. Commonly they have clinical practice experience and professional education background. They believe that guidelines will be of help to the clinical practice of acupuncture and moxibustion, hope that WFAS CPGs would recommend effective guidelines for acupuncture manipulation and provide the latest progress in acupuncture treatment and so on, and they believe that classical ancient books can guide their clinical practice. It indicates the necessity and feasibility of formulating the WFAS CPGs of acupuncture and moxibustion. In view of the results of this study, it is suggested that the formulation process of WFAS CPGs of acupuncture and moxibustion should take into account the clinical practice level of acupuncture and moxibustion in each region, as well as its legislation and management situation of acupuncture and moxibustion, so as to meet the needs of users as much as possible.     

针灸防治肿瘤相关性抑郁状态的临床实践指南研究

目的:探索针灸防治肿瘤相关性抑郁状态的临床实践方案,为制定临床实践指南提供依据。方法:人工检索49本古代医籍,收集关于针灸疗法治疗抑郁的古代文献证据;计算机检索国家知识基础设施数据库（CNKI）、中国医学生物文献数据库（CBM）、中国学术期刊数据库（CSPD）及中文科技期刊数据库（CCD）、Pubmed、EMBASE、Cochrane Library等数据库,全面收集针灸疗法治疗肿瘤相关性抑郁的现代文献证据;制定发放《针灸干预肿瘤相关性抑郁状态调查问卷》,收集针灸干预肿瘤相关性抑郁状态的现代专家经验。通过整合3方面证据形成针灸防治肿瘤相关性抑郁状态临床推荐方案。结果:古代医籍文献相关条目共14项;现代文献共检索到137篇文献,通过对文献进行纳入排除,最终纳入14篇现代文献,包括中文文献8篇,英文文献6篇;临床专家问卷共收回52份。综合3方面研究结果发现针灸治疗肿瘤相关性抑郁状态常用毫针针刺、电针、艾灸、耳穴贴压等疗法;常用穴位为神门、内关、印堂、百会、合谷、足三里、气海、三阴交、阴陵泉、太冲、肝俞、太溪、肾俞、心俞等。结论:综合3方面证据形成针灸防治肿瘤相关性抑郁状态的临床推荐应用方案,弱推荐使用毫针针刺、电针、艾灸、耳穴贴压疗法;推荐使用穴位为神门、内关、印堂、百会、合谷、足三里、气海、三阴交、阴陵泉、太冲、肝俞、太溪、肾俞、心俞等。     

Evidence-based clinical practice guidelines for acupuncture-moxibustion treatment of scapulohumeral periarthritis

The aim of this study was to establish clinical practice guidelines for acupuncture-moxibustion by retrieving relevant literature and adopting the best current national and international evidence, according to experts' experience and patients' values. This was achieved using the Grade of Recommendations Assessment, Development and Evaluation (GRADE) system combined with a wide range of national experts' consensus, in order to provide reliable evidence for acupuncture-moxibustion treatment of scapulohumeral periarthritis, and to ensure the safety and effectiveness of the treatment.     

建立循证中医临床实践指南证据分级体系的构想

通过阐述证据分级体系在循证临床实践指南的重要地位,中医学和西医学临床证据特点的对比分析,评析了建立循证中医临床实践指南证据分级体系的各种设想,提出了具有本学科学术特点的中医文献证据分级标准。     

针灸推拿专业大学生实践能力培养模式的探索

以国家实验教学示范中心为依托,探索出了针灸推拿技能培养5年不断线、临床见习“早入手,早锻炼”、实践活动体验培养、学生社团提高培养和针刺竞赛大众化的学生实践能力培养模式,取得了良好的效果.     

腹针针具粗细小议

为了探讨腹针针具粗细在腹针临床工作中的重要性,本文以对古代针具发展的文献记载的总结为基础,以针具的现代理论研究及临床应用发展为依据,结合在针灸临床上的体会,对针具粗细在腹针临床疗效中的影响进行了探讨,认为针具粗细会对补泻作用产生不可忽视的影响。即对于虚性的疾患,宜用相对较细的针具,对于实性的疾患,宜用相对较粗的针具。故不同的患者,不同的病证,选用相对不同粗细的针具,可使针效大大提高。     

针灸临床研究的现状分析

目的：探讨针灸临床研究的现状。方法：通过检索中国知网数据库相关文献,选择针灸临床研究方面的文献资料,总结针灸临床研究的现状,为后续针灸临床研究提供参考意见。结果：目前关于针灸临床研究资料中,基本涉及了所有针灸临床治疗的所有疾病研究,但是国内的文献资料相对比较简单,研究方案设置比较简单、重复类研究较多,且大多方案缺乏科学性和经不起更进一步的推敲,主要表现在方法学和疗效评价标准上,同时很多针灸临床研究资料脱离了中医理论体系,单纯的套用西医的研究方法,使资料的可信度大大降低。结论：应发展出既能被严格的现代科学研究标准所接受,又不失中医针灸临床实践精髓的研究方法,从而恰当评价针灸临床应用的价值。     

A SURVEY OF EPILEPSY TREATED WITH ACUPUNCTURE AND MOXIBUSTION IN RECENT YEARS

In this paper,we have introduced the developing tendencies and features of the treat-ment of epilepsy with acupuncture and moxibustion.studies on the naechanism of the therapeutic ef-fect.the evaluation of the clinical effect and some problems in the last 10 years.Moreover,we haveput forward our opinions for improving the treatment in future.     

针灸治疗面瘫临床常用治法与刺法的评价

目的　了解建国以来针灸治疗面瘫的临床研究现状及能否向临床实践提供有可靠依据的治法和刺法。方法　采用循证医学和临床流行病学评价文献质量的原则和方法对针灸治疗面瘫的临床研究文献进行全面检索和方法学质量评价。结果　在实际检出的 96 3篇文献中 ,随机对照试验 (RCT)的文献 83篇 ,目前 RCT提供了针灸治疗面瘫有效的可靠依据及针灸治疗面瘫常用的治法与刺法。结论　针灸治疗面瘫最常用的治疗方法是毫针、电针、灸法等 ,最常用的针刺方法是透刺法、浅刺法等 ,而且透刺法优于浅刺法。