Accuracy of acupuncture point location among first-year acupuncture students: A pilot study evaluating the impact of training and use of an adjustable ruler.

BACKGROUND: The proportional method of acupuncture point location (APL) currently taught at Endeavor College of Natural Health and advocated by the World Health Organization Regional Office for the Western Pacific (WPRO) was found to be imprecise and/or inaccurate in previous student studies. The ruler and elastic methods of APL were identified as more accurate or precise than the proportional method of APL but were not well received by student participants. Use of an adjustable ruler may overcome barriers to uptake of the more accurate APL methods. This pilot study was the first to evaluate the comparative accuracy of the adjustable ruler and the proportional methods of APL in first-year students at a major Australian acupuncture training college. METHODS: After 10 weeks of in-class instruction in both proportional and adjustable ruler methods of APL, student participants (n = 14) attempted location of three acupuncture points (LI10, SP6 and ST38) on a volunteer using both APL methods of interest. A self-administered questionnaire and lecturer field notes elucidated attitudes to implementation of both APL methods. RESULTS: Points marked using the adjustable ruler were closer to the correct location than those marked using the proportional method across all three acupuncture points. Students and lecturers rated the adjustable ruler more highly than the proportional method for ease of learning and ease of use. CONCLUSION: Encouraging results with the adjustable ruler method warrant further larger scale studies. Use of the adjustable ruler method of APL should be considered for use in point location training at educational institutions teaching traditional acupuncture.

The importance of regulating the education and training of Traditional Chinese Medicine practitioners and a potential role for ISO/TC 249.

As Traditional Chinese Medicine (TCM) transcends its cultural boundaries and becomes widely used in many countries around the world, one of the major risks to the growing use of TCM internationally is the damage caused to its reputation and to community safety when TCM practitioners are not adequately trained. Ensuring the quality and competency of TCM practitioners is a fundamental requirement. This paper covers (1) the current level of regulation of education and training of TCM practitioners particularly in countries with well developed health systems; (2) the progress of self regulatory standards for education and training developed by international organizations and (3) the potential role of ISO/TC 249 in assisting these initiatives.

[Status of acupuncture service quality control].

In order to guarantee and improve the quality of acupuncture service, the developments of the control of acupuncture service quality in the World Health Organization (WHO) and various countries were summarized. A number of normative documents that could improve acupuncture service security and effectiveness have been developed in WHO and many countries, in which, acupuncture training, safety manipulation and the guidelines for clinical practice of disease have been included. There are great differences in the qualification authentication and management of acupuncture practitioners among different countries. In China and South Korea, the official government departments are in charge of the management, but, in most of the countries, the qualification attestation examination of acupuncture is conduced mainly by the national/local industry organizations authorized by the state and operated by the commissioned experts. The medical service quality evaluation system is complicated. Because of the specific characteristics of acupuncture discipline itself, it is necessary to develop the service quality assessment system and the standard which is especially adaptable in acupuncture discipline.

A Survey of Licensed Acupuncturists in the San Francisco Bay Area: Prevalence of Treating Oncology Patients.

BACKGROUND: Many cancer patients seek traditional Chinese medicine (TCM), the prevalence varying with diagnosis, comorbidities, and demographics. Interventions sought include acupuncture, massage, herbs, diet, and exercise, usually combined with conventional therapies. It is not known what proportion of TCM practitioners care for cancer patients, their cancer specific training or caseload, what interventions they employ, their outcomes, and their communication patterns with conventional oncologists. METHODS: A survey was mailed to all 2213 licensed acupuncturists in the 9-county San Francisco Bay Area gathering descriptive statistics. RESULTS: A total of 472 (21%) responded by mail or web-based Research Electronic Data Capture (REDCap) tool. Most respondents (77%) reported caring for patients with cancer, with 29% reporting having 6 to 10 years of practice experience, and 44.2% having 0 to 20 hours of training specific to the needs of patients with cancer. Improving quality of life was reported by 94% as what their treatment offered cancer patients as well as the area where treatment was felt to have the greatest impact. The most useful TCM modalities were acupuncture (98%), herbs (79%), diet (72%), moxibustion (46%), and meditation instruction (44%). Absence of adverse reactions was noted by 95%. Ninety-one percent reported "never" or "hardly ever" having been contacted by patients' oncologists to discuss treatment. CONCLUSIONS: Many acupuncturists seeing cancer patients have significant clinical experience and have sought specialized training. Improved communication is needed between TCM practitioners and oncologists sharing care of cancer patients.

[Differences and international standardization between acupuncture as therapy and as specialty].

The purpose of this study is to explore the differences of definition and clinical roles as well as international standardization between acupuncture as therapy and as specialty, which can provide reference evidence for specialization and internationalization of acupuncture. Owing to the clinical efficacy and safety, the credibility and controversy both exist in acupuncture; moreover, there is a lack of fair definition and international precedent regarding acupuncture specialty. Therefore, it is particularly essential to objectively compare the differences of definitions and clinical roles as well as criteria of international standardization for acupuncture as therapy and as specialty. It is believed acupuncture standardization can draw lessons from the international medical standards, evidence-based medicine and acupuncture theory from the following three major projects:acupuncture safety and contraindications; acupuncture indications and treatment guidelines; acupuncture indication classified into 3 levels of evidence-based acupuncture disease spectrum, as objective evidence of indication of acupuncture specialty.

[The current situation of acupuncture definition in international organizations and legislation of some countries].

Acupuncture is developing rapidly in the world, and more attention is paid on acupuncture in various countries. Because of the cultural differences, there are different views on acupuncture between China and the west, which has brought influence and challenge to the development of acupuncture in the world. Acupuncture-related research is becoming increasingly extensive and complex, but the definition of acupuncture is lack of unified standards. The definition of acupuncture is in urgent need. Based on the analysis of acupuncture definition in the 201 international organizations of 48 countries on five continents and legislation of representative countries, this paper summarized the development status of acupuncture in foreign countries, and put forward that the definition of acupuncture should adopt the model of small connotation and large extension, integrate discipline superiority, expand the scope of acupuncture, and focus on the overall situation.

[Science of Acupuncture and Moxibustion should include standards related to acupuncture and moxibustion].

The development of Science of Acupuncture and Moxibustion should be in accord with the trend of standardization and internationalization of the science of acupuncture and moxibustion. Based on the arrangement of chapters and sections in the textbook, 29 national standards, 6 standards or guidelines made by World Health Or- ganization(WHO) and 1 standard out of International Standardization Organization (ISO) are classified and intro- duced. It is suggested that the above contents should be considered as the evidence when the textbook is reedited. Also, it is proposed that humanization should be supplemented and the newest research findings should be traced.

[Doubting the twirling angle of filiform needle in Science of Acupuncture and Moxibustion textbooks and National Standards].

In National Standards (GB) as well as the textbooks used in TCM universities, the twirling angles of acupuncture manipulation vary a lot. By reviewing the previous editions of textbooks from 3 publication houses and comparing the relevant contents, the author calculated the arc lengths of various twirling angles based on the specification of filiform needle in National Standards (GB) and International Standards (ISO). The conclusion is that the twirling angles mentioned in National Standards (GB) and textbooks are too small and not in compliance with the clinical practice. Hence, it is not advisable to propose a rigid specific provision of twirling angle in acupuncture manipulation.

[Investigation for use of The Name and Location of Acupoints(GB/T 12346-2006), national standard].

To understand the use in recent 10 years of The Name and Location of Acupoints(GB/T 12346-2006),a standard of The People's Republic of China,so as to provide the evidence for its further establishment and revision,we investigated and analyzed the application of The Name and Location of Acupoints through relevant literature and the textbook. It is found that making use of the standard is being realized in various types of articles and it is described in almost all the textbooks. Implementing the standard intensively promotes the standardization of acupuncture-moxibustion education and clinical manipulation as well as the academic exchange domestically and overseas. In turn,its scientificalness and authority are further strengthened.

[Standardizing the manipulation procedure of acupuncture-moxibustion, reinforcing the training of' clinical skill: learning experience of Acupuncture-moxibustion Clinical Skills Training: Chapter of Commonly Used Needling and Moxibustion Techniques].

The book Acupuncture-moxibustion Clinical Skills Training is one of "Twelfth Five-Year Plan" in novative teaching materials, which is published by People's Medical Publishing House. Through learning the first half of the book commonly used needling and moxibustion techniques, it is realized that the selection of book content is reasonable and much attention is paid to needling and moxibustion techniques; the chapter arrangement is well-organized, and the form is novel, which is concise and intuitive; for every technique, great attention is paid to standardize the manipulation procedure and clarify the technique key, simultaneously the safety of acupuncture and moxibustion is also emphasized. The characteristics of the book, including innovativeness, practicability, are highlighted, and it greatly helps to improve students' clinical skills and examination ability.

[Principles and Methods for Formulating National Standards of "Regulations of Acupuncture-nee- dle Manipulating techniques"].

The national standard of "Regulations of Acupuncture-needle Manipulating Techniques" is one of the national Criteria of Acupuncturology for which a total of 22 items have been already established. In the process of formulation, a series of common and specific problems have been met. In the present paper, the authors expound these problems from 3 aspects, namely principles for formulation, methods for formulating criteria, and considerations about some problems. The formulating principles include selection and regulations of principles for technique classification and technique-related key factors. The main methods for formulating criteria are 1) taking the literature as the theoretical foundation, 2) taking the clinical practice as the supporting evidence, and 3) taking the expounded suggestions or conclusions through peer review.

[The trajectory of the introduction and regulation of acupuncture in Brazil: recollections of the challenges and struggles]. / A trajetória da introdução e regulamentação da acupuntura no Brasil: memórias de desafios e lutas.

Based on the life experiences of acupuncturists, the scope of this study was to examine the struggle to obtain regulation of the practice of acupuncture in Brazil. The method used was Oral Live History, the core issue being the dimension of the human experience involved in this trajectory of struggles and challenges. We conducted ten interviews, following the set of procedures demanded by the Oral History technique. The information contained in the narratives was analyzed and, taking the interpretive approach called immersion/crystallization as a benchmark, the central themes of the work were established, based on which which the discussion was developed. The results indicate the emergence of highly controversial themes involving political, corporate and cultural aspects, which constitute central elements within a historical process still under development.

Standardisation of moxibustion: challenges and future development.

International organisations such as WHO and the International Organization for Standardization are increasingly committed to the development of traditional Chinese medicine (TCM). Moxibustion is an integral modality of acupuncture that has been in use for thousands of years. It stands out as a health choice due to its potential effects in disease prevention, health promotion and maintenance, as well as affordability and accessibility. As the use of moxibustion increases, concerns are being raised regarding its safety and quality. The need to establish standards to protect patient safety is paramount in all medical fields. As a form of medical practice, it is essential to develop moxibustion standards in the areas of terminology, moxibustion products, treatment rooms and practice to ensure its harmonisation and safe usage. The evidence base guiding policy and decision making has to be based on evidence from basic and clinical research. Promoting strategic basic and clinical research on the safety and effectiveness of moxibustion will answer some of the fundamental questions surrounding moxibustion, create a climate of awareness and acceptance and, in turn, drive its standardisation.

[ZHU Lian's New Acupuncture Academic System and acupuncture science initialization].

Acupuncture scientization was a consensus of most of acupuncture scholars who had long-term perspectives in the 20th century, among them Ms. ZHULian was the important one. Ms. ZHU Lian built a systemic new acupuncture" academic structure in practice and theory aspects. At the same time, as the main architect of Institute of Acupuncture-moxibustion of China Academy of Traditional Chinese Medicine, Ms. ZHU Lian was the first one who began to carry out the acupuncture clinical trail and laboratory experiment in modern way, which meant "acupuncture therapy" was transformed into "acupuncture science" by Ms. ZHULian's endeavor.

[The development of World Federation of Acupuncture-Moxibustion Societies].

From cooperation between World Federation of Acupuncture-Moxibustion Societies (WFAS) and World Health Organization, works of academics and standardization, acupuncture-moxibustion education, technique service, organization development, etc., the 27-year development of WFAS since 1987 was summarized and reviewed in details. The growth of WFAS witnesses and promotes the development of acupuncture and moxibustion in the world, so by learning the experience and lessons, WFAS could have a wider path, becoming a core organization for communicating and promoting the development of acupuncture, even the traditional medicine in the world.

[How to establish a good acupuncture-moxibustion standard?].

At the beginning of a standard item, the standardized objects and involved contents should be demonstrated thoroughly, which is the precondition of establishing a good standard. After the proposal of this standard, a high-level drafting group should be built, led by top specialists who also draft the standard, which is essential to guarantee the quality of the standard. Before drafting the standard, literature regarding this standard should be searched completely, and Directives for Standardization should be learned to understand the basic requirements of establishing a standard; in the meanwhile, selections on standardized contents and quantitative boundaries of technical indices should be comprehensively and deeply studied. At the stage of consultation, focus should be paid on the scope of the consultation departments, level and personnel quality. As for standard review, it should be precise and truth-seeking. At the stage of submitting and authorization, it is necessary to have timely communication. Only by full cooperations of all parties, and by strictly following the procedure, method and rule of standard establishment, can a high-quality acupuncture-moxibustion standard be established.

[On the interrelationship between standardization and intellectual property rights of acu-moxibustion therapy].

Under the condition of knowledge economy, the acu-moxibustion standardization definitely involves intellectual property rights. Then, what is the relationship between the standardization and the intellectual property rights of acu-moxibustion? The authors of the present paper hold that it is not only exclusive, but also syncretic. If their relationship cannot be handled properly, their own respective development will be affected adversely. Therefore, a proper handling of the relationship between the two is of great practical significance. The present paper makes a comprehensive analysis about their interaction (mutual promotion and mutual inhibition), similarities (systemic composition, dynamic implementation course, standardization-rated order and ultimate targets) and differences (in properties, working components, secret requirement, effectiveness-time limitation, usage cost, etc).

[On the necessity of intellectual property rights involving standardization of acupuncture and moxibustion therapies].

In the process of working out and implementing standardization of acupuncture-moxibustion (acu-moxi) therapy, the issue of intellectual property rights has been frequently involved. Whether is the standardization inevitably involved in intellectual property rights? A reasonable answer to this question is definitely of important realistic guiding value and significance for acu-moxi standardization work. For this reason, authors of the present paper sum up historical development of correlation between acu-moxi standardization and intellectual property rights, and fully analyze the related causes under the conditions of knowledge economy from 1) increasing protection of acu-moxi intellectual property rights, 2) intrinsic requirements for raising the standardization level of acu-moxi, 3) profits drive of the intellectual property rights owners, and 4) increasing impetuous international economic trade competition.

[Quantitative research on operation behavior of acupuncture manipulation].

OBJECTIVE: To explore a method of quantitative evaluation on operation behavior of acupuncture manipulation and further analyze behavior features of professional acupuncture manipulation. METHODS: According to acupuncture basic manipulations, Scales for Operation Behavior of Acupuncture Basic Manipulation was made and Delphi method was adopted to test its validity. Two independent estimators utilized this scale to assess operation behavior of acupuncture manipulate among 12 acupuncturists and 12 acupuncture-novices and calculate interrater reliability, also the differences of total score of operation behavior in the two groups as well as single-step score, including sterilization, needle insertion, needle manipulation and needle withdrawal, were compared. RESULTS: The validity of this scale was satisfied. The inter-rater reliability was 0. 768. The total score of operation behavior in acupuncturist group was significantly higher than that in the acupuncture-novice group (13.80 +/- 1.05 vs 11.03 +/- 2.14, P < 0.01). The scores of needle insertion and needle manipulation in the acupuncturist group were significantly higher than those in the acupuncture-novice group (4.28 +/- 0.91 vs 2.54 +/- 1.51, P < 0.01; 2.56 +/- 0.65 vs 1.88 +/- 0.88, P < 0.05); however, the scores of sterilization and needle withdrawal in the acupuncturist group were not different from those in the acupuncture-novice group. CONCLUSION: This scale is suitable for quantitative evaluation on operation behavior of acupuncture manipulation. The behavior features of professional acupuncture manipulation are mainly presented with needle insertion and needle manipulation which has superior difficulty, high coordination and accuracy.