Does Modern Research Concerning Chinese Medicine Acupoints Relate to Original Prescriptions? If Not, Why Not?

Objective: Huang Fu Mi's Zhen Jiu Jia Yi Jing (ZJJYJ) is regarded as the earliest text (282 ce) on differential diagnosis and clinical acumoxa therapy in Chinese Medicine. Are contemporary manual acupuncture practices consistent with those reported in the ZJJYJ? The aim of this research was to investigate if modern manual acupuncture uses reported in research are consistent with classical practices reported in the ZJJYJ. Materials and Methods: A database search of human research studies from 1995 to 2016 was performed for all 270 acupoints for all 8 leg/body channels. The clinical foci of these modern publications were compared with acupoint clinical indications documented in the Song Dynasty Chinese edition (1077) of the ZJJYJ and the sole English translation (translated and compiled by Yang and Chace in 1994) of The Systematic Classic of Acupuncture and Moxibustion. Results: Of 2149 articles in English, 63 met the search criteria. These articles predominately reported acupoints on the lower leg, back, chest, and head. Correlations between the acupoints used in modern research and those used in the ZJJYJ were minimal. Clinical indications from the ZJJYJ typically involved symptoms relating to pain, swelling, fever, seizures, hallucinatory states, dysentery, malaria, and tuberculosis, which are now treated pharmacologically. However, one-third of modern studies were functional magnetic resonance imaging (fMRI) investigations of neurophysiologic effects of manual acupuncture on the human brain. Conclusions: While, superficially, the ZJJYJ might seem irrelevant in modern manual acupuncture practices, well-documented physical effects (e.g., pain relief) of manual acupuncture do provide measurable outcomes for use in fMRI research. Therefore, the classical text does provide a guide for future research on influential acupoints on the leg and body channels.

Investigating the effects of three needling parameters (manipulation, retention time, and insertion site) on needling sensation and pain profiles: a study of eight deep needling interventions.

Introduction. In traditional Chinese acupuncture, needle sensation (deqi) is purported to contribute to a therapeutic outcome. While researchers have attempted to define deqi qualitatively, few have examined the effects of needling parameters on its intensity. Methods. 24 healthy subjects completed eight interventions scheduled at least one week apart, which involved manual acupuncture to LI4 or a designated nonacupoint (NAP) on the hand, with real or simulated manipulation each three minutes and needle retentions of one or 21 minutes. Intensities of needling sensation and pain were reported every three minutes and sensation qualities were reported post-intervention. Results. Immediately after needle insertion, similar levels of mean needle sensation and of pain were reported independent of intervention. At subsequent measurement times, only two interventions (one at LI4 and one at NAP) maintained statistically significantly elevated needle sensation and pain scores and reported higher numbers of needle sensation descriptors. For both, the needle was retained for 21 minutes and manipulated every three minutes. Neither intervention differed significantly in terms of levels of pain, and needle sensation or numbers and qualities of needle sensation described. Conclusion. In this group of healthy subjects, the initial needling for all eight interventions elicited similar levels of needle sensation and pain. These levels were only maintained if there was ongoing of needle manipulation and retention of the needle. By contrast, the strength of needle sensation or pain experienced was independent of insertion site.

An innovative method to accommodate Chinese medicine pattern diagnosis within the framework of evidence-based medical research.

Pattern diagnosis is an integral aspect of Chinese medicine (CM). CM differentiates biomedical diseases into patterns, based upon the patient's symptoms and signs. Pattern identification (PI) is used to diagnose, direct the treatment principle and determine the treatment protocol. Most CM research has used fixed formula treatments for Western-defined diseases with outcomes measured using objective biomedical markers. This article presents an innovative method used in a randomised controlled pilot study using acupuncture for participants with hepatitis C virus. Each participant's CM patterns were identified and quantified at baseline which directed the treatment protocol for the treatment group. Data identified that while each participant expressed different patterns at baseline all participants displayed multiple patterns. Six patterns showed some expression by all 16 participants; Liver (Gan) yin vacuity expressing a group aggregate mean percentage of 47.2, binding depression of Liver qi 46.9, and Liver Kidney (Shen) yin vacuity 45.1. Further sub category gender grouping revealed that pattern ranking changed with gender; Liver yin vacuity (male 53.4%, female 51.93%), binding depression of Liver qi (male 50.0%, female 42.86%) and Liver Kidney yin vacuity (male 42.9%, female 47.96%). The quantification of CM patterns described in this article permitted statistical evaluation of presenting CM patterns. Although this methodology is in its infancy it may have potential use in the integration of PI with rigorous evidence based clinical research. Biomedical markers often do not relate to symptom/signs and therefore this innovative measure may offer an additional CM evaluation methodology and further CM PI understanding.

A novel approach to evaluate Traditional Chinese Medicine treatment outcomes using pattern identification.

INTRODUCTION: Traditional Chinese Medicine (TCM), a modern interpretation of Chinese medicine, developed in the 1950s. It differentiates biomedical diseases into patterns. Each pattern comprises symptom/signs that have their own unique treatment protocol. Most TCM research has used fixed formula treatments for Western-defined diseases with outcomes often measured using objective biomedical markers. More recently, a number of trials have attempted to accommodate TCM clinical practice within the framework of rigorous evidence-based medical research. The aim of this article is to describe a novel outcome measure based on TCM patterns that was used in a pilot study for people with hepatitis C virus (HCV). METHODS: Sixteen (16) participants with HCV were enrolled in a randomized, controlled pilot study and allocated to a treatment or control group. TCM pattern diagnosis was obtained at baseline and used to guide acupuncture treatment for the treatment group. Each individual's primary, secondary, and tertiary TCM patterns were identified, which involved the systematic evaluation of the participant's information against the TCM patterns and conversion of the pattern to a percentage. Baseline and postintervention percentages for the three TCM patterns for the two groups were compared to assess change. RESULTS: There was a significant mean percentage decrease in pattern expression at week 12 compared to baseline for the secondary and tertiary patterns of the treatment group (56.3% versus 47.5%; p = 0.045 and 48.1% versus 33.6%; p = 0.037, respectively). No significant change was found for the primary, secondary, or tertiary patterns for the control group or for the primary pattern associated with the treatment group. CONCLUSIONS: The quantification of TCM patterns in this study permitted statistical evaluation of TCM pattern change. Previously, TCM pattern identification had only been used as a basis for developing the treatment protocol in clinical trials. This is the first time it has been employed as a novel outcome measure.

Altered motor control, posture and the Pilates method of exercise prescription.

The objectives of this study were to compare the effects of three different Pilates regimes on chronic, mild low back pain symptoms and to determine whether the efficiency of load transfer through the pelvis is improved by those exercises. A between subjects equivalent group experimental design was used. The independent variable was the type of exercise training (three groups) and the two-dependent variables were low back pain symptoms and load transfer through the pelvis. The outcome measures of the first-dependent variable were a comparison between modified Oswestry Disability Questionnaires (one of the standard pain instruments) completed pre- and post-program and frequency, intensity and duration of low back pain. The outcome measure of the second-dependent variable, efficiency of load transfer through the pelvis was the Stork test (one-legged standing test) in weight bearing. Although all groups experienced statistically significant reductions in frequency, intensity and duration of low back pain across the weeks of exercising, there were no significant differences between the groups relative to each other.

Traditional Chinese medicine tongue inspection: an examination of the inter- and intrapractitioner reliability for specific tongue characteristics.

AIM: To examine the reliability of Traditional Chinese Medicine (TCM) tongue inspection by evaluation of inter- and intrapractitioner agreement levels for specific tongue characteristics, achieved by a group of TCM practitioners. METHOD: Ten (10) realistic tongue slides and a set of questionnaires were used to examine the agreement levels among 30 TCM practitioners in two data collection sessions. Statistical analysis involved descriptive statistics, predominantly percentage frequency agreement with the agreement level of > or =80% set as the criterion for an acceptable level of reliability. RESULTS: Overall, both inter- and intrapractitioner agreement levels were low. Only on 19 occasions (17.3%) in session 1 and 21 occasions (19.1%) in session 2 were interpractitioner (between a practitioner) agreement levels of > or =80% achieved. Moreover, virtually all (15 occasions in session 1 and 14 occasions in session 2) of these questions involved simple dichotomous response choices, and the practitioners achieved levels of > or =80% reliability in only 5% of occasions where more complex response choices were offered. In terms of intrapractitioner (within a practitioner) agreement, the highest agreement level was achieved for the dichotomous response choice questions on presence of coat and presence of crack, with the 29 and 20 practitioners achieving > or =80% intrapractitioner agreement, respectively. Only 2 subjects achieved higher than 80% intrapractitioner agreement level for all tongue slides on all questions, with the highest intrapractitioner agreement level being 88% followed by 82%. The findings showed that the TCM tongue inspection for specific characteristics examined was not a reliable diagnostic method, at least for the group of TCM practitioners involved in this study. CONCLUSIONS: The findings suggest that a major contribution to the low levels of inter- and intrapractitioner agreements stems from inadequate operational definitions of both the tongue characteristics studied and of the inspection regions of the tongue.

A comparison of effects on regional pressure pain threshold produced by deep needling of LI4 and LI11, individually and in combination.

OBJECTIVES: To compare the effects of unilateral and bilateral needling of the same acupoint, and the effects of individual and combined needling of two distinct acupoints on pressure pain threshold (PPT). DESIGN: 22 subjects completed the randomised, dual blind (subject and evaluator) repeated measures study. PPT was measured before and after each intervention at ten sites (acupoints and nonacupoints) across the body with an algometer. INTERVENTIONS: The same manual acupuncture techniques were applied to four interventions of large intestine 4 (LI4) unilaterally; LI4 bilaterally; large intestine 11 (LI 11) unilaterally; and LI4 in conjunction with LI11, both unilaterally. MAIN OUTCOME MEASURES: (1) Percentage change in PPT from preintervention baseline measured at the 10 regional sites following every intervention; (2) participants' perceptions of pain; needling sensations; tension during, and anxiety prior to, each intervention; and changes in practitioner behaviour. RESULTS: Following all four interventions, statistically significant increases in mean PPT were observed. These occurred at nine sites following the LI4 intervention either unilaterally or bilaterally; at six sites for LI11 intervention; and at five sites following the combined LI11 and LI4 intervention. These increases were significantly greater for the bilateral LI4 intervention than the unilateral LI4 intervention at only two sites (p < 0.02 and p < 0.0001). There were no statistically significant differences in the subjective perceptions among the four interventions. CONCLUSION: The enhanced effects on PPT by the bilateral compared with the unilateral intervention at LI4 although limited, do provide some support for the traditional Chinese medicine (TCM) assumption that bilateral needling of the same point enhances the treatment effect. There was no support for the assumption that combined needling of points from the same channel should enhance the treatment effect and failure to obtain better effects by combined needling of points from the same channel could result from the interaction occurring during the combined needling.

The testing of classical pulse concepts in Chinese medicine: left- and right-hand pulse strength discrepancy between males and females and its clinical implications.

OBJECTIVES AND DESIGN: The use of the radial pulse as a diagnostic tool is an important part of the Chinese medicine (CM) clinical evaluation. This study reports the findings of an investigation into inter-arm pulse strength differences in subjects and the relationship to traditional pulse claims relating to gender. METHOD: Using a standardized pulse taking procedure and concrete operational definitions, two pulse assessors with a demonstrated high level of inter-rater agreement each assessed the overall left and right pulse strength and rated their findings on a standardized pulse form. RESULTS: The overall percentage of inter-rater agreement for manual assessment of dominant hand was 86% (based on a cohort of 65 subjects). In relation to the three possible choices regarding dominant side (right, neither, left) the right-hand side was most commonly selected as relatively strongest of the two regardless of gender (60% of males and 71% of females). Analysis of the data using Chi-square (II) found the observed frequencies for an assessor's rating of dominant hand in males were significantly different to those expected according to CM theory. CONCLUSIONS: The CM assumption of gender-related pulse-strength differences in left and right hand pulses was not supported within this study.

A study of the relative precision of acupoint location methods.

OBJECTIVE: This study examined the relative precision of four methods of acupoint location: two traditional methods (directional and proportional) and two contemporary methods (elastic and ruler). DESIGN: Seventy-two (72) subjects attempted to locate a fictitious acupoint (FP) with repeated attempts and the resulting coordinates were recorded. LOCATION: The research was carried out at the Acupuncture Clinic of the University of Technology, Sydney (UTS). SUBJECTS: The 72 subjects were selected from undergraduates of the Bachelor of Health Science in Acupuncture course. RESULTS: Analysis of the results found no significant difference in precision between the two traditional methods, nor between the two contemporary methods. However, the contemporary methods were both shown to be significantly more precise than the traditional methods (F(3,120) = 11.74, p < 0.0001). CONCLUSIONS: Based on the scatter size resulting from the use of each method, the surface area of the acupoint would need to range from almost 13 cm(2) for the directional method to less than 3 cm(2) for the ruler method if 95% of the subjects were to locate the acupoint successfully. Implications and recommendations for research and education are discussed.

The reliable measurement of radial pulse characteristics.

The use of the radial pulse as a diagnostic tool is an integral part of the Traditional Chinese Medicine (TCM) patient evaluation. In spite of its long history of use, there is little systematic information available to support the many claims about the relationship between pulse qualities and physiological condition contained in the ancient Chinese texts and echoed in modern pulse terminology. This study reports the development of a reliable means of measuring and recording pulse characteristics. This was achieved by reporting on the physical sensations that are detected under the fingertips when the radial pulse is palpated, rather than attempting to translate these into the complex and typically ambiguously defined TCM pulse qualities. The study involved development of a standardised pulse taking procedure and development of concrete operational definitions for each of the characteristics of the pulse being measured. The inter-rater reliability of the pulse taking procedure and operational definitions was assessed by determining agreement levels between two independent pulse assessors for each characteristic. Inter-rater agreement averaged 80% between the two assessors in both the initial data collection (66 subjects) and in a replication collection (30 subjects) completed two months later. Demonstrating reliability of the procedure represents an essential first step for examining the validity of TCM pulse diagnosis assumptions.

The reliable measurement of radial pulse: gender differences in pulse profiles.

This study was undertaken to determine whether healthy adults exhibited characteristic pulse profiles. Pulse characteristics measured for 83 women and 65 men included presence at the Traditional Chinese Medicine (TCM) locations (Cun, Guan, Chi); and depth (superficial, middle, deep), overall pulse force, relative pulse force, pulse width and pulse rhythm. Most subjects had similar values for many of the characteristics investigated including relative pulse force at the three traditional palpation locations (Cun, Guan and Chi), pulse width and pulse rhythm. There were some significant gender differences. The pulse was present beyond Chi in 90% of males compared with 56% of females. Female pulses tended to be less forceful compared with males. However, with the exception of overall force, there was little support for TCM assumptions of gender differences in pulse such as in left/right balance. There was some support for the use of the TCM palpation locations Cun, Guan and Chi to discriminate between pulses since there was significant differences in manifestations of some pulse characteristics among these locations.