[Preliminary study on the existing problems in health economic evaluation study of acupuncture in China].

The literature of health economic evaluation study in the field of acupuncture in China was systematically summarized and analyzed, and the existing problems in the current research were discussed from the aspects of research perspective, cost calculation scope, data analysis method selection. Moreover, the key points of the health economic evaluation research were summarized, and the research objectives, the relationship between the expected research results and data analysis methods and the process of thinking were sorted out, and several suggestions for research report writing were proposed, aiming to provide a reference for the quality improvement of the acupuncture health economic evaluation research in China.

[Quality control in the implementation of multi-center acupuncture clinical trial].

The paper introduced the experiences of quality management in the implementation of multi-center acupuncture clinical trials and the keys in training acupuncture operators. The process management was explained in view of the division of labor for researchers, protocol learning and the communication among sub-centers. Besides, specificity links of acupuncture research were summarized, i.e. meaning implementation brief of acupuncture operation training, control for quantity of stimulus in acupuncture and doctor-patient communication. It is anticipated to provide a valuable reference for the quality control and improvement of multi-center acupuncture clinical trial in future.

[Criteria of "arrival of qi" of acupuncture from "reaction of spirit produces curative effect": inheriting SHI Xue-min's thoughts of treating spirit].

From "arrival of qi produces curative effect", it is considered that arrival of qi, qi reaching and acupuncture sensation cannot contain the effect attribute, location attribute and performance attribute of acupuncture at the same time, so it is necessary to find a more suitable standard to measure the arrival of qi and clinical curative effect. Inspired by "the arrival of qi should be reaction of spirit, and reaction of spirit produces curative effect", the authors propose to use the term "reaction of spirit" to summarize the numerous external manifestations of arrival of qi, and to coordinate the attributes of arrival of qi, qi reaching and acupuncture sensation. Academician SHI Xue-min guides the clinical treatment with "reaction of spirit produces curative effect", attaches importance to the spirit treatment to improve the clinical curative effect, and evaluates whether acupuncture is successful or not with "reaction of spirit".

[Application and thinking of cohort study in clinical research of acupuncture and moxibustion].

Cohort study has been greatly considered and widely used in clinical research of traditional Chinese medicine in China, but it is seldom applied in the field of acupuncture and moxibustion. This paper introduces the development background, basic concepts, advantages and limitations of cohort study, analyzes the existing problems in the evaluation of acupuncture and moxibustion curative effect and development status of cohort study in the cycle of acupuncture and moxibustion, explores the feasibility and value of such method in clinical research of acupuncture and moxibustion and proposes the methodological suggestions on rigorous design, control of selective bias, control of cohort migration and reduction of loss to follow-up, aiming at broadening the new ideas andmethods for clinical research of acupuncture and moxibustion.

[Pivotal issue of acupuncture-moxibustion academical inheritance based on the present situation of the clinical application of Tongguan Liqiao needling method by the academician SHI Xue-min].

The present situation of clinical application of Tongguan Liqiao needling method of acupuncture innovated by academician SHI Xue-min, and the situation for the inheritance of academic thought were analyzed. It was found that during the application of Tongguan Liqiao needling method, some questions were presented, i.e. absence of main acupoints in acupuncture regimen, lack of rules for the selection of combined acupoints and lack of specification on manipulation. The reasons of the above questions were analyzed from three aspects of inheritance, i.e. integrity, systematicness and normativity. It is anticipated that the summary of this analysis may provide the references to the efficient development of normative clinical manipulation and academic inheritance.

The effect of acupressure on pain reduction during first stage of labour: A systematic review and meta-analysis.

BACKGROUND AND PURPOSE: Acupressure, as part of Traditional Chinese Medicine, has shown promise as an effective method of pain relief in labour and birth. This systematic review and meta-analysis aims to critically assess the effect of acupressure on pain reduction during first stage of labour. METHODS: Five major electronic databases were searched in November 2018 to screen English articles. Only randomized controlled trials (RCTs) comparing acupressure with placebo and/or no intervention were selected. Intensity of labour pain was considered for primary outcome and pooled analysis. RESULTS: Ten RCTs were included in this review. LI4 and SP6 were the most commonly used acupoints. At the active and transitional phase, acupressure significantly reduced labour pain when compared to placebo (pooled MD -1.91; 95% CI -2.73,-1.08; pooled MD -3.03; 95% CI -5.03,-1.02, respectively). Acupressure was also superior to no intervention group at the active (pooled MD -3.00; 95% CI -3.88,-2.13) and transitional phase (pooled MD -2.03; 95% CI -3.72,-0.35). CONCLUSION: Acupressure can provide significant pain relief during first stage of labour. However, further clinical trials with standardized intervention procedures are required for the creation of evidence-based guidelines.

[Effect of acupuncture on left ventricular configuration and cardiac function in patients with hypertension].

OBJECTIVE: To observe the related factors of left ventricular configuration in patients with mild to moderate hypertension, and to evaluate the influence of acupuncture on left ventricular configuration and cardiac function. METHODS: Huoxue Sanfeng acupuncture regime formulated by academician SHI Xue-min was applied to 200 patients with mild to moderate hypertension. The treatment was given once a day, 5 times a week for 3 months. Blood pressure and blood lipid levels were measured before treatment. Before treatment and 3 months after treatment, the echocardiography was used to measured end-diastolic left ventricular diameter (LVIDd), end-diastolic left ventricular posterior wall thickness (LVPWTd), and end-diastolic interventricular septum thickness (IVSTd), ejection fraction (EF), left ventricular mass index (LVMI), etc.; the relevant influencing factors of different left ventricular configurations were analyzed. RESULTS: The patients with mild to moderate hypertension had left ventricular dysplasia (left ventricular remodeling, concentric hypertrophy, eccentric hypertrophy) reached 60%, and compared with the normal configuration group and the left ventricular remodeling group, there were significant differences in nighttime mean pulse pressure, total cholesterol, BMI and waist circumference in the eccentric hypertrophy group (P<0.05). LVMI was associated with nighttime pulse pressure, waist circumference, total cholesterol and BMI (P<0.05). Left ventricular relative wall thickness was associated with total cholesterol, BMI and waist circumference (P<0.05). The diastolic function from normal configuration to left ventricular remodeling, concentric hypertrophy and eccentric hypertrophy gradually decreased, but there were no significant difference (P>0.05). The systolic function in the concentric hypertrophy group and the eccentric hypertrophy group was significantly lower than that in the normal configuration group and the left ventricular remodeling group (P<0.05). There was no significant difference in left ventricular systolic function and diastolic function before and after acupuncture (P>0.05). CONCLUSION: Sixty percents of patients with mild to moderate hypertension have abnormal left ventricular configuration and are associated with total cholesterol, BMI, waist circumference and nighttime mean pulse pressure. Studies have not found that acupuncture can significantly improve the left ventricular configuration and left cardiac function.

[Idea of shen-brain-orifice in the acupuncture system of Xingnao Kaiqiao].

Academician SHI Xue-min innovatively proposed that "closed minds and shen don't guide the qi " is the general pathogenesis of stroke, and created the Xingnao Kaiqiao acupuncture therapy, which is based on the theory of "brain" and the idea of "treating shen" is the core connotation. It is based on "Xing Nao" "Xing Shen" and "adjust shen". The clinical application has also extended to different types of diseases. Despite the differences in the allocation of acupoints, the therapeutic principles are always related to the shen, brain and orifice. In this paper, the author explains the meaning and interrelationship of shen, brain, and orifice by quoting ancient literature and the views of modern scholars, which is helpful to understand and inherit the academic thought of academician SHI Xue-min.

[Effects of acupuncture on carotid intima-media thickness and cerebral blood flow velocity in patients with mild-to-moderate hypertension].

OBJECTIVE: To observe the characteristics of carotid intima-media thickness (IMT) and cerebral blood flow velocity in patients with mild-to-moderate hypertension, and to evaluate the effects of acupuncture on carotid IMT and blood flow velocity of middle cerebral artery and vertebral-basilar artery. METHODS: A total of 240 patients with mild-to-moderate hypertension who met the inclusion criteria were treated with Huoxue Sanfeng acupuncture method proposed by academician SHI Xue-min. The acupoints of Renying (ST 9), Quchi (LI 11), Hegu (LI 4), Zusanli (ST 36) and Taichong (LR 3) were selected. The treatment was given once a day, five times a week for 3 months. The carotid ultrasonography and transcranial color Doppler were performed before treatment and 3 months after treatment to evaluate the improvements of carotid IMT and brain blood flow velocity. RESULTS: Among 175 patients, 94.3% suffered from impaired carotid IMT. After acupuncture intervention, 7.7%-10.9% patients had improved IMT but 4.6%-6.3% had aggravated carotid IMT. There was no significant difference of carotid IMT before and after treatment (P>0.05). About 50% patients had abnormal intracranial blood flow velocity; after acupuncture intervention, 27.4%-33.3% patients who had the abnormal blood flow velocity had normal one, but 27.0%-52.5% patients who had normal blood flow velocity had abnormal one. After acupuncture intervention, the low-speed blood flow of MCA, VA and BA in female patients aged 41-60 years and the low-speed blood flow of MCA and VA in female patients aged 61-70 years were significantly improved (all P<0.05); the high-speed blood flow of MCA and VA in male patients aged 61-70 years and the high-speed blood flow of VA and BA in female patients aged 41-60 years were significantly decreased (all P<0.05). CONCLUSION: Nearly 95% of patients with mild-to-moderate hypertension had carotid IMT, and about 50% had abnormal blood flow velocity of intracranial artery. The present study failed to found significant effects of acupuncture on carotid IMT, but it shows acupuncture can generally improve the low blood flow velocity in women with mild-to-moderate hypertension.

Therapeutic effects of different durations of acupuncture on rats with middle cerebral artery occlusion.

Acupuncture is regarded as an effective therapy for cerebral ischemia. Different acupuncture manipulations and durations may result in different therapeutic effects. In the present study, the Neiguan (PC6) acupoint of rats with occluded middle cerebral arteries was needled at a fixed frequency (3 Hz) with different durations, i.e., 5, 60 and 180 seconds under a twisting-rotating acupuncture method. Results showed that different durations of acupuncture had different therapeutic effects, with 60 seconds yielding a better therapeutic effect than the other two groups. This duration of treatment demonstrated rapid cerebral blood flow, encouraging recovery of neurological function, and small cerebral infarct volume. Experimental findings indicated that under 3 Hz frequency, the treatment of needling Neiguan for 60 seconds is effective for ischemic stroke.

[Different stimulation intensities of acupuncture at Hegu (LI 4) for central facial nerve paralysis after ischemic stroke: a randomized controlled trial].

OBJECTIVE: To observe the clinical efficacy of acupuncture at Hegu (LI 4) on central facial nerve paralysis after ischemic stroke, and explore dose-effect relationship among different stimulation intensities of acupuncture at Hegu (LI 4) as well as its optimal treatment plan. METHODS: According to different acupuncture stimulation intensities which were based on treatment time and needle insertion direction, fifty patients were randomly divided into a Hegu 1 group, a Hegu 2 group, a Hegu 3 group, a Hegu 4 group and a control group, ten cases in each one. Different stimulation intensities of acupuncture at Hegu (LI 4) combined with facial paralysis acupoints, including Yingxiang (LI 20), Dicang (ST 4), Jiache (ST 6) and Quanliao (SI 18), were applied in Hegu 1 to 4 groups; meanwhile acupuncture at stroke acupoints, including Neiguan (PC 6), Shuigou (GV 26) and Sanyinjiao (SP 6), and medication treatment were adopted. Except acupuncture at Hegu (LI 4), the treatment of the control group was identical as Hegu groups. The treatment duration lasted for 14 days. The House-Brackmann facial never grading systems (H-B), Toronto facial grading system (TFGS), degrees of facial never paralysis (DFNP), facial disability index (FDI) and clinical efficacy were compared among groups. RESULTS: (1) Compared before the treatment, H-B, TFGS, DFNP and physical function score in FDI were all improved significantly in the Hegu 1 to 4 groups (all P < 0.05), but social function score in FDI was not obviously improved (all P > 0.05); all the scores in the control group were not evidently changed (all P > 0.05). (2) Compared with the control group, differences of H-B before and after treatment in the Hegu 1 to 4 groups, differences of TFGS in the Hegu 2 group and differences of DFNP in the Hegu 1 and Hegu 2 group were significantly improved (all P < 0.05). The differences of any scale among Hegu 1 to 4 groups were not significant (all P > 0.05), in which the most evident change was found in Hegu 2 group. (3) The total effective rate was 90.0% (9/10), 100.0% (10/10), 90.0% (9/10) and 80.0% (8/10) in Hegu 1 to 4 groups, which were significantly higher than 60.0% (6/10) in the control group (all P < 0.05). CONCLUSION: Acupuncture at Hegu (LI 4) has affirmative clinical efficacy on central facial nerve paralysis after ischemic stroke, in which oblique insertion along the opposite direction of meridian for 5 s of twirling manipulation has the best clinical effect.

Study on acupuncture parameters impacting on the acupuncture effect using cluster analysis in a rat model with middle cerebral artery occlusion.

OBJECTIVE: To investigate the influence of acupuncture parameters on the acupuncture effect through the cluster analysis in Wistar rat model with middle cerebral artery occlusion (MCAO). METHODS: Duplicated MCAO models by Zea-longa's thread ligation and chose rats with 1-3 scores assessed by Zausinger's six-score method to be grouped. The rats were divided into 6 basic control groups [(including a normal group, a sham group, a model control group, a model group without intervention, a Nimodipine group, a lateral-to-Renzhong (DU6) group] and 6 acupuncture groups [a Neiguan (PC6) group, a Weizhong (BL40) group, a Sanyinjiao (SP6) group, a Chize (LU5) group, a Renzhong (DU6) group and a Feixue (non-acupoint) group]. In the acupuncture groups, for every acupoint or needling site, 9 different parameters [2 factors (frequency and time) and 3 levels (180, 120, and 60 cpm of the frequency and 5, 60, and 180 s of the time)] were set respectively by the orthogonal intersection method, in total 54 groups. The rats were treated by acupuncture with a lifting-thrusting manipulation once every 12 h, in total 6 times. Neurobehavioral scores, cerebral blood flow, infarction rate, microcirculation, light microscopy, etc. were measured. The factor analysis was first applied to get the comprehensive effect scores of the samples in the acupuncture groups and then by which the cluster analysis was made with the statistical software of SPSS17.0. RESULTS: For the Neiguan (PC6) group, the exceptional results of acupuncture comprehensive effect were parameters 7, 8, 9, 10; the valid results were parameters 2, 3, 4, and the invalid were parameters 5, 6. For the Weizhong (BL40) group, the exceptional results were parameters 2, 4; the valid results were parameters 3, 5, 6, 7, and the invalid were parameters 8, 9, 10. For the Chize (LU5) group, the exceptional results were parameters 7, 8; the valid results were parameters 3, 4, 5, 6, 9, 10; and the invalid was parameter 2. For the Sanyinjiao (SP6) group, the exceptional results were parameters 4, 6; the valid results were parameters 2, 3, 5; and the invalid were parameters 7, 8, 9,10. For the Renzhong (DU6) group, the exceptional results were parameters 3, 4, 6, 7, 9, 10; the valid results were parameters 2, 5; and the invalid was parameter 8. For the Non-acupoint group, the exceptional result was parameter 10; the valid results were parameters 2, 3, 4, 7, 9; and the invalid were parameters 5, 6, 8. CONCLUSIONS: For each meridian acupoint, different acupuncture parameters could consequently get a different acupuncture effect; each meridian acupoint had the most suitable or optimal acupuncture parameters; acupuncture parameters might be the main factors impacting on acupuncture effect.

[Contribution of Professor SHI Xue-min's academic thoughts to treatment of stroke].

Based on the thought of Zhishen (a kind of mind regulation), Professor SHI Xue-min, academician of the China Academy of Engineering, found the Xingnao Kaiqiao (to refresh the mind and to cause resuscitation) acupuncture method, which still plays an important role in the acupuncture treatment of wind stroke nowadays. Meanwhile, great importance is attached to the comprehensive treatment of wind stroke. Danqi Piantan capsule (see text) is developed and "wind stroke unit" is set up. In recent years, Professor SHI shifts the center of research to the treatment of hypertension, the risk factor of wind stroke. Taking Renying (ST 9) as the major acupoint, acupuncture with standard measurement and manipulations is established. And good clinical effect has been obtained as well. Therefore, this article focuses on the introduction of Professor SHI Xue-min's contribution to wind stroke treatment.

Cluster analysis for acupoint specificity of acupuncture effect based on cerebral infarction rat model.

OBJECTIVES: To study the acupoint specificity through the comprehensive evaluation of the acupuncture effect on rat model with the middle cerebral artery occlusion (MCAO). METHODS: Duplicated MCAO model by Zea-longa's thread ligation was assessed by Zausinger's six-point method, and rats with 1-3 scores were chosen to be grouped. According to the randomized and controlled principle, rats were divided into 6 basic control groups (including normal group, sham group, model control group, model group without intervention, Nimodipine group, lateral-to-Renzhong group) and 6 acupuncture groups [including Neiguan (PC6) group, Weizhong (BL40) group, Chize (LU5) group, Sanyinjiao (SP6) group, Renzhong (DU6) group and non-acupoint group]; in each acupoint or non-acupoint 9 different parameter combinations were respectively set by orthogonal intersection method. There were in total 60 groups, and each group had 12 rats. The rats were treated by acupuncture with the lifting-thrusting manipulation every 12 h, in total 6 times. Indices of neurobehavioral scores, cerebral blood flow, infarction rate, microcirculation, and light microscope, etc. were measured. In order to comprehensively evaluate the acupuncture effect to research the specificity of acupoint, a cluster analysis was made with SPSS17.0 for the comprehensive effect scores of the samples computed according to the comprehensive evaluation models, and then sorting and classification were made for the comprehensive effect scores. RESULTS: In the acupuncture groups every acupoint had different therapeutic effect due to different acupuncture parameter combinations; among the acupuncture groups the orders of curative effect were as followings: Neiguan group was of exceptional result, Weizhong group and Sanyinjiao group were of valid results in upper level, Chize group and Renzhong group were of valid results in lower level, and non-acupoint group was of invalid result; the therapeutic result of acupoint group was superior to non-acupoint group; and the curative effect of acupuncture group was also superior to basic control group. CONCLUSION: The acupoint has the specificity of acupuncture effect, and the acupoint specificity is relative.

[Efficacy judgment for treating ischemic stroke by acupuncturing at Neiguan (PC6) and the screening for optimal parameters].

OBJECTIVE: To select optimal parameters and judge the comprehensive effect of acupuncture. METHODS: The middle cerebral artery occlusion (MCAO) rat model was duplicated. Nine acupuncture parameters groups were set up by the frequency of acupuncture (slow, medium, and fast: 60, 120, and 180 times/min) and the acupuncture duration (short, medium, and long: 5, 60, and 180 s). Twisting technique was used in needling at Neiguan (PC6). By taking neurological impairment scoring, leptomeningeal cerebral blood flow, microcirculation (input branch diameter, output branch diameter, input/output), and cerebral infarction rate as effect indicators, the comprehensive effects of different acupuncture parameters at Neiguan (PC6) on MCAO were determined by factor analysis, thus screening the optimal parameters. RESULTS: By factor analysis, the highest score for comprehensive effect could be achieved with the acupuncture parameters of 180 times/min and 60 s. That is to say, fast frequency and middle time duration could achieve the optimal acupuncture effects, suggesting that appropriate acupuncture time duration should be used under the condition of guaranteeing fast frequency when treating ischemic stroke by needling at Neiguan (PC6). CONCLUSION: The 180 times/min and 60 s were the optimal parameter group when needling at Neiguan (PC6) by twisting technique for treating ischemic stroke.

[Thinking on acupuncture finger force in the acupuncture quantity study].

As an important link during the whole operation process of acupuncture, it is very necessary to launch quantity study closely related to acupuncture finger force in the acupuncture quantity study. After retrieval of related literatures on finger force during acupuncture in recent 20 years, it was found out that although some exploration on acupuncture finger force had been made, it was scattered and had no deep research, which pointed out it was a weak link in the acupuncture quantity study. So study of finger force should be paid attention to in acupuncture-moxibustion field, the level of theoretical and experimental research and development of measuring instrument on acupuncture finger force should be strengthened, the application of instrument should be expanded in teaching and scientific research areas, which could promote the modernization and internationalization of acupuncture and moxibustion better and faster.

Influence of acupuncture on neural movement function in rats with middle cerebral artery occlusion--a randomized controlled trial.

OBJECTIVES: To observe recovery in movement function in rats with middle cerebral artery occlusion (MCAO) after acupuncture treatment. METHODS: According to the randomized and controlled principle 1384 rats were divided into the basic control group (including the normal, sham, model control, model without intervention, Nimodipine, and para-Renzhong groups) and the acupuncture group (including the Neiguan (PC 6), Weizhong (BL 40), Sanyinjiao (SP 6), Chize (LU 5), Renzhong (GV 6) and non-acupoint groups). MCAO was modeled by Zea-longa's thread ligation and rats with scores of 1-3, as assessed by Zausinger's six-point method, were used in this study. Moreover, in the acupuncture group each acupoint was set with 12 different parameters by the orthogonal intersection method, resulting in 78 groups with 18 rats per group. The rats were treated by acupuncture once every 12 h for a total of six sessions and neurobehavioral scores were measured after each session. The neurobehavioral scores were compared by one-way ANOVA using the statistical software SPSS 17.0. RESULTS: After acupuncture therapy the mean neurobehavioral scores in MCAO rats increased gradually at each time point with a significant difference among the six scores, but with no significant differences between the fourth (48 h) and the fifth score (60 h), and between the fifth (60 h) and the sixth (72 h) score (P > 0.05). CONCLUSIONS: MCAO rats gradually recovered movement function over multiple acupuncture sessions. After the fouth acupuncture session (48 h), the neurobehavioral scores of rats with cerebral infarction remained stable. Acupuncture treatment had a reliable curative effect on movement function in cerebral infarction rats.

[Study progression on the specificity of meridian points effectiveness].

The present situation of the study on the specificity of meridian points effectiveness through checking up the relevant literatures on the study of this subject published in recent 10 years from the databases such as CNKI and SCI are summarized in the paper. It is indicated in the summarization that the effectiveness of meridian points is specific and the meridian points bring their role into play probably through the biological mechanism in the body. But, it is still limitative in systematic, complete and scientific study on such conclusion. In future, the relevant study is required by adopting adequately modern scientific technology and facility, strict and scientific experiment designs as well as assessment method and taking extensive diseases or disease models as the carriers.

[Dynamic observation on therapeutic features of thalamic pain by mind calming, blood activating and pain relief acupuncture and carbamazepine].

OBJECTIVE: To observe therapeutic features of thalamic pain by mind Calming, blood activating and pain relief acupuncture and Carbamazepine. METHODS: Crossover trial design was adopted. Eleven patients with confirmed diagnosis of thalamic pain were randomly assigned to two groups according to the minimal unbalance index method, i.e., Group I (Six patients received acupuncture first and then Western medicine.) and Group II (Five patients received Western medicine first and then acupuncture). The therapeutic course for each group was ten days. There was a ten-day elution phase between the two therapeutic methods. The total therapeutic course was thirty days. Eleven patients were enrolled in the two groups for statistical analysis. The therapeutic efficacy was assessed with visual analogue scale (VAS) and the pain assessment scale of Anderson Cancer Center in the USA (MD Pain Evaluation value) respectively. The VAS and MD values of the two groups were recorded every day to get the dynamic curve. RESULTS: The VAS and MD values obviously decreased in the two groups after treatment (P<0.05). The pain curves of the two groups showed a declining trend during the treatment. A gradual and stable descending process was shown in the acupuncture group. But a greater decrease first appeared in the Western medicine group, then a comparatively greater decrease occurred after one platform stage, showing ladder-shaped curve. CONCLUSIONS: Cumulative potency may be the main analgesic effects of acupuncture. Western medicine may possibly play a role by rapid initiate effect.