El valor de la acupuntura en la práctica de la medicina tradicional complementaria en el sector salud de México / The value of acupuncture in the practice of complementary traditional medicine in Mexico's health sector

Introduction: Complementary traditional medicine acquires an essential value from the diversity and pluralism of care and therapy. In this logic, it is up to people to search for alternatives when it comes to caring for and improving their own health. Specifically, acupuncture has had rapid growth, largely due to processes derived from globalization, migration and cultural exchange, which in some way force countries to modify their health system towards one that takes into account the transculturality of its population and treatment preferences. Development: With the establishment of a comprehensive health model, physicians can assess the person as a homeodynamic process (information exchange process between environment and man, to keep an internal and external homeostasis to the individual) and pandimensional (spiritual and energetic care) that allows to identify the health problem's origin and thus determine an intervention more in line with the person's needs during the health-disease, life-death processes, with the corresponding conventional or non-conventional therapy. Conclusions: The value and interest of acupuncture in the population derives from the degree of development of a country, its origin and the incorporation of the West as part of the diagnostic and therapeutic arsenal, in order to respond to the population needs by incorporating low-cost complementary treatments with proven effectiveness, without ceasing to consider its unquestionable cultural heritage.

Introducción: la medicina tradicional complementaria adquiere un valor imprescindible desde la diversidad y el pluralismo de la asistencia y la terapéutica. En esa lógica, corresponde a las personas la búsqueda social de alternativas cuando se trata de atender y mejorar la propia salud. En específico la acupuntura ha tenido un rápido crecimiento, en gran parte debido a la globalización, la migración y el intercambio cultural, que de alguna forma obligan a los países a modificar su sistema de salud hacia uno que tome en cuenta la transculturalidad de su población y las preferencias de tratamiento. Desarrollo: con el establecimiento de un modelo de salud integral, los médicos pueden valorar a la persona como un proceso homeodinámico (intercambio de información entre el ambiente y el hombre para mantener una homeostasis interna y externa del individuo) y pandimensional (cuidado espiritual y energético) que permita identificar el origen real del problema de salud y determinar una intervención más acorde a las necesidades de la persona durante los procesos de salud-enfermedad, de vida-muerte, con la terapia convencional o no convencional que corresponda. Conclusiones: el valor e interés de la acupuntura en la población se deriva del grado de desarrollo de un país, de su origen y de la incorporación de occidente como parte del arsenal diagnóstico y terapéutico, para responder a las necesidades de la población al incorporar tratamientos complementarios de bajo costo y con efectividad demostrada, y sin dejar de considerar su herencia cultural incuestionable.

Functionalized acupuncture needle as a SERS-active platform for rapid and sensitive determination of adenosine triphosphate.

The development of sensitive and rapid methods for analysis and detection of small molecules is highly desirable for medical diagnostics and therapeutics. We report an acupuncture needle functionalized with gold nanoparticles (Au NPs) and a macrocyclic amine (MA) Raman tag as the platform to realize the sensitive detection of adenosine triphosphate (ATP) by surface-enhanced Raman spectroscopy (SERS). The assembled Au NPs with abundant hot spots on the surface of the needle avoids the aggregation of Au NPs and results in a good signal response. Moreover, there is strong combination between ATP and MA through electrostatic adsorption, hydrogen-bonding interactions, and π-π stacking, and as a consequence, this functionalized needle can be used as a SERS platform for detection of ATP (25 nM) through a decrease of the Raman signal of MA resulting from the high chemical affinity of ATP for MA. Specially, the Au NP/MA-functionalized needle is conveniently used to monitor ATP (100 nM) added to serum, and demonstrates great promise in the study and detection of ATP in a complex sample, laying the foundation for SERS applications in complex acupuncture specimens with fast response and simple operation. Graphical abstract.

Dipping probe electrospray ionization/mass spectrometry for direct on-site and low-invasive food analysis.

Rapid, direct, on-site and noninvasive food analysis is strongly needed for quality control of food. To satisfy this demand, the technique of dipping probe electrospray ionization/mass spectrometry (dPESI/MS) was developed. The sample surface was pricked with a fine acupuncture needle and a sample of ∼200 pL was captured at the needle tip. After drying the sample, the needle tip was dipped into the solvent for ∼50 ms and was moved upward. A high-voltage was applied to the needle to generate electrospray when the needle reached the highest position, and mass spectra were measured with a time-of-flight mass spectrometer. For evaluation of the method, the technique was used to analyze foods such as vegetables, salmon flesh, cow's milk, yogurt, and soy-bean milk. The detected major ions for cow's milk and yogurt were [(Lac)n + Ca]2+ with n = 1-6 (where (Lac) is lactose), indicating that Ca2+ is tightly bound by Lac molecules.

[Professor ZHAO Jiping's thoughts and methods of penetration needling].

As a vital part of acupuncture and moxibustion,the theory of penetration needling obviously lags behind the practice. This article summarizes the thoughts andmethods of penetration needling by professor ZHAO Jiping. Based on the three basic elements of penetrating acupuncture, including the acupoint, needle and manipulation, the academic origins, the application of penetrating acupuncture at present and the clinical cases are reviewed; the essential content and the extension meaning of needle penetration are summarized, which is based on the identification of the location, pathology and characteristics of disease, combined with the characteristics of acupoints and the tissue structure of the part, we quantify the intensity of stimulation, so as to provide featured reference clinical practice.

Motion video-based quantitative analysis of the 'lifting-thrusting' method: a comparison between teachers and students of acupuncture.

OBJECTIVE: To compare objective measures of needle manipulation between students and teachers of acupuncture using motion video analysis technology, to help support instructional acupuncture education. METHODS: A total of 30 teachers and 60 students participated in this study. Acupuncture needles were inserted at LI11 and motion videos were recorded for three subtypes of 'lifting-thrusting' manipulation: (1) 'mild reinforcing-attenuating'; (2) 'reinforcing'; and (3) 'attenuating'. The videos were analysed using Simi Motion 3D software to acquire the movement parameters of four trace marks: 'thumb tip'; 'forefinger tip'; 'forefinger middle joint'; and 'forefinger base joint'. Differences between the two groups were compared using t-tests, X2 tests and/or rank-sum tests. RESULTS: Changes in the near-end interphalangeal joint were positively associated with a range of movement along the X axis. Motion parameters for the thumb tip, the proximal interphalangeal (PIP) joint of the forefinger and the X axis shaft swing near the end of the forefinger in the teacher group were higher than those in the student group. The teacher group featured smaller trough dispersion and smaller crest dispersion during 'reinforcing' and 'attenuating' manipulations, respectively. CONCLUSIONS: The 'lifting-thrusting' manipulation could be simplified as a fixed-axis rotation using metacarpophalangeal joints in the thumb and forefinger as the shaft centre. Teachers opened at a larger angular variation for the PIP during the lifting and thrusting processes with better spatial control. Temporal control was similar between groups and therefore appears easier to grasp. Repetitive training might be helpful for improving athletic and spatial stability during needle manipulation.

Eficacia de la acupuntura en la espasticidad del paciente que ha padecido un ictus. Revisión sistemática / Effectiveness of acupuncture in spasticity of the post-stroke patient. Systematic review

OBJETIVO: Determinar la eficacia de la acupuntura para la reducción de la espasticidad en el paciente que ha sufrido un ictus. DISEÑO: Revisión sistemática. Fuente de datos: Búsqueda sistemática en las principales bases de datos de los ensayos clínicos, publicados en español e inglés desde enero de 2000 a enero de 2013, en los que los participantes cursaran con espasticidad a consecuencia de un ictus. Selección de los estudios: Se seleccionaron 9 registros de los 110 localizados. Los criterios de inclusión fueron: ensayos clínicos en pacientes con una edad igual o superior a 18 años, con espasticidad post-ictus y que al menos uno de los grupos experimentales fuese tratado con acupuntura. EXTRACCIÓN DE DATOS: Las principales variables analizadas fueron la resistencia pasiva al estiramiento del miembro afecto y el grado de dependencia personal. Fueron valoradas mediante la escala modificada de Ashworth y el índice de Barthel, respectivamente. MÉTODO: Realizamos una búsqueda en las bases de datos PUBMED, COCHRANE Library, PEDro, Dialnet, CSIC, CINAHL. Se empleó la combinación de los términos «acupuntura», «espasticidad» e «ictus». RESULTADOS: La resistencia pasiva al estiramiento, el grado de dependencia personal y la función motora del miembro afecto mostraron mejoras estadísticamente significativas en al menos un estudio de los incluidos. Se observó una mejora de la resistencia pasiva al estiramiento en codo, tobillo, rodilla y muñeca, hubo un incremento del rango articular, excepto en codo, antebrazo y dedo pulgar, y una mejora de la dependencia de los pacientes. CONCLUSIÓN: Aunque se muestran mejoras respecto a la reducción de la espasticidad, la eficacia de la técnica no ha podido demostrarse para esta enfermedad. Son necesarios estudios que calculen el tamaño de los efectos reportados, aplicando procedimientos homogéneos en el diseño así como en la duración, frecuencia e instrumentos de medida utilizados

OBJECTIVE: To determine the effectiveness of acupuncture for reducing spasticity in post-stroke patients. DESIGN: Literature review. Data source: The literature search was performed using scientific databases from January 2000 to January 2013. SELECTION OF STUDIES: Out of the 110 studies that were found, nine random and controlled trials were included. Inclusion criteria were based on clinical trials in which participants were over 18 years old, who were suffering with post-stroke spasticity, and one of the experimental groups was treated with acupuncture. Data extraction: The variables were the passive resistance to stretching of the affected limb, and the degree of personal dependence. The variables were assessed by the Modified Ashworth Scale and Barthel Index. METHODS: The search was performed in the PUBMED, COCHRANE Library, PEDro, Dialnet, CSIC, CINAHL, databases. Search terms included the combination of keywords 'acupuncture'; 'muscle spasticity'; 'stroke'. RESULTS: Passive resistance to stretching, the degree of personal dependence, and motor function of the affected limb showed statistically significant improvements in at least one study included; however, these improvements are not clinically relevant changes. Passive resistance improved in the elbow, ankle, knee, and wrist. An increased joint range was observed, except for the elbow, forearm, and thumb. Improved of the patient dependency was also observed. CONCLUSIONS: Although improvements relative to the reduction of spasticity are shown, the results have failed to demonstrate the effectiveness of the technique for this ailment. It would take a greater number of studies to calculate the size of the reported effects with homogeneous procedures in the design as well as in the duration, frequency, and measurement tools

[Human body meridian spatial decision support system for clinical treatment and teaching of acupuncture and moxibustion].

The spatial position and distribution of human body meridian are expressed limitedly in the decision support system (DSS) of acupuncture and moxibustion at present, which leads to the failure to give the effective quantitative analysis on the spatial range and the difficulty for the decision-maker to provide a realistic spatial decision environment. Focusing on the limit spatial expression in DSS of acupuncture and moxibustion, it was proposed that on the basis of the geographic information system, in association of DSS technology, the design idea was developed on the human body meridian spatial DSS. With the 4-layer service-oriented architecture adopted, the data center integrated development platform was taken as the system development environment. The hierarchical organization was done for the spatial data of human body meridian via the directory tree. The structured query language (SQL) server was used to achieve the unified management of spatial data and attribute data. The technologies of architecture, configuration and plug-in development model were integrated to achieve the data inquiry, buffer analysis and program evaluation of the human body meridian spatial DSS. The research results show that the human body meridian spatial DSS could reflect realistically the spatial characteristics of the spatial position and distribution of human body meridian and met the constantly changeable demand of users. It has the powerful spatial analysis function and assists with the scientific decision in clinical treatment and teaching of acupuncture and moxibustion. It is the new attempt to the informatization research of human body meridian.

[Status of diagnosis and treatment devices of acupuncture based on SooPAT and bibliometrics in China].

OBJECTIVE: To perform a bibliometrics analysis on patent literature regarding diagnosis and treatment devices of acupuncture in China, aiming to provide references for the development of diagnosis and treatment devices of acupuncture. METHODS: Based on SooPAT, a patent database, the patent literature regarding diagnosis and treatment devices of acupuncture in China was collected. With bibliometrics methods, the annual distribution of type, quantity, classification and content of diagnosis and treatment devices of acupuncture were analyzed. RESULTS: The number of acupuncture diagnosis and treatment devices reached its peak in 2012 and 2013 in China. The A61N in patent and utility model patent were the most, which were mainly related to electrotherapy, magnetic therapy, radioactive therapy and ultrasound therapy, etc. The main content was acupuncture treatment devices and meridian treatment devices. The 24-01 in design patent was the most, involving fixation devices used by doctors, hospitals and laboratories, etc. CONCLUSIONS: Currently the majority of diagnosis and treatment devices of acupuncture is therapeutic apparatus, while the acupuncture diagnosis devices are needed.

[Inheritance and evolution of acupuncture manipulation techniques of Zhejiang acupuncture masters in modern times].

There are many eminent acupuncture masters in modern times in the regions of Zhejiang province, which has developed the acupuncture schools of numerous characteristics and induces the important impacts at home and abroad. Through the literature collection on the acupuncture schools in Zhejiang and the interviews to the parties involved, it has been discovered that the acupuncture manipulation techniques of acupuncture masters in modern times are specifically featured. Those techniques are developed on the basis of Neijing (Internal Classic), Jinzhenfu (Ode to Gold Needle) and Zhenjiu Dacheng (Great Compendium of Acupuncture and Moxibustion). No matter to obey the old maxim or study by himself, every master lays the emphasis on the research and interpretation of classical theories and integrates the traditional with the modern. In the paper, the acupuncture manipulation techniques of Zhejiang acupuncture masters in modern times are stated from four aspects, named needling techniques in Internal Classic, feijingzouqi needling technique, penetrating needling technique and innovation of acupuncture manipulation.

Preparation of Graphene-Modified Acupuncture Needle and Its Application in Detecting Neurotransmitters.

We report a unique nanosensing platform by combining modern nanotechnology with traditional acupuncture needle to prepare graphene-modified acupuncture needle (G-AN), and using it for sensitive detection of neurotransmitters via electrochemistry. An electrochemical deposition method was employed to deposit Au nanoparticles (AuNPs) on the tip surface of the traditional acupuncture needle, while the other part of the needle was coated with insulation paste. Subsequently, the G-AN was obtained by cyclic voltammetry reduction of a graphene oxide solution on the surface of the AuNPs. To investigate the sensing property of the G-AN, pH dependence was measured by recording the open circuit potential in the various pH buffer solutions ranging from 2.0 to 10.0. What's more, the G-AN was further used for detection of dopamine (DA) with a limit of detection of 0.24 µM. This novel G-AN exhibited a good sensitivity and selectivity, and could realize direct detection of DA in human serum.

[Preliminary study on lacquer figure with meridian-points marked of the western Han dynasty unearthed in Laoguanshan, Chengdu].

The lacquer figure with meridian-points marked of the western Han dynasty, unearthed in Tianhui town, Jinniu district, Chengdu in 2012, has been the earliest and the most complete human figure of meridian-acupoints in China so far. There were over ten courses of meridians, and over 100 visible acupoints as well as multiple intaglio inscriptions. All of them are valuable in academic study. The writers introduced the lacquer figure un- earthed in Laoguanshan in terms of the briefs and characteristics of meridian and acupoint distributions, which give the references to the future studies.

[From manual workshop to international standard maker: exploration on production standard of acupuncture needle by Chengjiang acupuncture school].

ABSTRACT The exploration course on production standard of acupuncture needle by Chengjiang acupuncture school is reviewed in this paper. After new China was established, acupuncture needle standard was unified by Mr. CHENG Dan-an, which guided Suzhou Hua Erfang (predecessor of Suzhou Medical Supplies Factory) to make the quality standards and testing methods of acupuncture needle and improved the production process to make the modern acupuncture needle. Based on this, Suzhou Medical Supplies Factory followed the time development pace, ac tively introduced new technology, carried out technological innovation, and constantly improved the level of production technology, as a result, it gradually developed into one of the world's largest acupuncture needle production suppliers. Meanwhile, after establishing China's first national standard on acupuncture needle (GB 2024-1980), the Suzhou Medical Supplies Factory took the lead to draft "ISO) 17218:2014 the disposable use asepsis acupuncture needle", which was officially published as an international standard. The Suzhou Medical Supplies Factory developed from a manual workshop to an international standard maker.

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.

Effect of blinding with a new pragmatic placebo needle: a randomized controlled crossover study.

Placebo control is a useful method for determining the efficacy of a therapy. In acupuncture researches, the preferred method for placebo control is acupuncture using a placebo needle that has a blunt tip and achieves no skin penetration. We performed a crossover study to validate the blinding effect of a new type of placebo needle. Sixty volunteers were randomized to receive acupuncture using 2 types of needles with different sequences: sequence AB, involving first the pragmatic placebo needle and then the real needle, and sequence BA, in a reverse order. Placebo acupuncture was performed by administering the placebo needle through an adhesive pad without skin penetration on the acupoints LI4, RN12, BL25, and BL36. Real acupuncture was performed by needling through the pad and penetrating the skin to 15 mm using a real needle on the same acupoints. The acupuncture was administered every other day with 3 sessions for 1 type of needle. The primary outcome was the perception of needle penetration. Besides degree of acupuncture pain, type, and degree of needle sensation, needle acceptability and factors influencing the subject blinding effect were assessed. Needle penetration was felt by 100%, 90% (54/60), 88.3% (53/60), and 95% (57/60) of volunteers receiving placebo acupuncture and 98.3% (59/60), 96.7% (58/60), 95% (57/60), and 95% (57/60) of volunteers receiving real acupuncture on LI4, RN12, BL25, and BL36, respectively. Differences of the volunteers' perception of needle penetration between the placebo needle and real needle were not significant for the 4 acupoints (all P > 0.05). Volunteers experienced fewer distension sensations (P = 0.01), a lower degree of needle sensation (P = 0.007), and less pain (P = 0.006) during placebo acupuncture than during real acupuncture. The placebo needle was more easily accepted than the real needle (OR = 1.63, 95% CI, 1.01-2.64). The influences of age, sex, educational level, acupuncture experience, needle sensation, acupuncture pain, and needle acceptability on volunteers' perception of needle penetration were not significant. The pragmatic placebo needle is a valid control for acupuncture research. It produces a good subject blinding effect with a similar appearance to conventional acupuncture needles and no skin penetration when applied.

[A brief talk on the embodiment of Three-Layer thought in the science of acupuncture and moxibustion].

Three-Layer thought is an important proposition in Chinese traditional philosophy. This thought embodies the Chinese people's cosmology and methodology and exerts a far-reaching influence on various aspects of Chinese culture. The embodiment of Three-Layer thought in the theory and practice of acupuncture and moxibustion from naming of acupoints, principles of treatment, needling instruments, prescription of acupoints as well as needling techniques is elaborated and briefly analyzed. Thus it illustrates the comprehensive application of Three-Layer thought in acupuncture and moxibustion through the history and the significance of Chinese traditional philosophy in the science of acupuncture and moxibustion.

[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.

[Operation training and 24-type simplex manipulation].

Operation training is the basic training of acupuncture, which includes practicing finger force and finger feeling. During practicing, it is essential to comprehend that needle is the carrier of force, and the force should be exerted through the needle, meaning the finger force should be put into the needle. There are four basic skills, including practicing qi, practicing finger, practicing spirit and practicing technique. Besides, there are three combinations, which are combination of spirit and finger, combination of force and qi and combination of qi and spirit. It is required to seek movement from peace and achieve fast from stable, also it needs to be swift through being steady, be dynamic through being static and be ingenious through being subtle. The techniques in the 24-type simplex manipulation are recorded in the ancient literature, and some arrangement and supplement is added and then summarized to classify this manipulation into six groups, including (1) search and pinch acupoint, activate meridian by finger and by nail; (2) swing, hover, twist and rub the needle; (3) insert, withdraw, lift and thrust the needle; (4) scrape, flip, fly and rub needle handle; (5) pull, push, vibrate and bend the needle; (6) press meridian and acupoint, seek meridian qi and stir the needle. It could provide positive effect on distinguishing and comprehending the manipulation.

[Thoughts and methods of study on acupuncture medical history: an example of Mr. MA Ji-Xing].

Mr. MA Ji-xing has devoted himself into the study of acupuncture medical history for more than 70 years. As a result, a great work of Zhenjiuxue Tongshi (see text), History of Acupuncture-Moxibustion) has been completed. The author has expensively studied for history of acupuncture medicine in time and space. Base on abundant historical materials, deliberate textual research as well as strategically situated academic view, it is considered as a masterpiece of acupuncture on real significance. It is worthwhile to note that the book has a systematic and profound explanation on Bian-stone therapy, unearthed literature relics of acupuncture, the bronze figure or illustration of acupoint as well as special topics of Japan and Korea acupuncture history. Filled several gaps of the field, and explored some significant new paths of study, it laid the groundwork for the profound study and unscramble of traditional acupuncture theory as well as the investigation of the academic history, which is considered to have a profound and persistent influence. The careful sorting and profound digging of many distinguish thoughts and methods of Mr. MA Ji-xing in the study of acupuncture medical history has significant meaning in references and enlightenment of the future research on acupuncture medical history.

[Question discussion on Theories of Different Schools of Acupuncture and Moxibustion, "the twelfth five-year plan" teaching material].

The several questions in Theories of Acupuncture and Moxibustion of Different Schools, "the twelfth five-year plan" teaching material, are analyzed and discussed. The expression of DOU Han-qing on "playing a role of meridians, collaterals, qi and blood" is not so accurate, which is suggested to modify as "attaching the importance to needles". "Theory of heaven, human being and earth" "theory of acupuncture on qi regulation" and "the eight therapeutic methods in treatment of disease" in Jinzhenfu (Ode to Golden Needles) are valuable academically and suggested to be supplemented. The expression of XI Hong on "reinforcing and reducing technique by following or against the running course of meridian" and the expression of XU Feng on "the magic turtle eight techniques" are not concrete. It is required to elaborate them in detail. These questions are put forward and needed to discuss with the editors so as to perfect the teaching material.