目的:探讨针灸疗法治疗卒中后失眠的有效性和安全性,以更好的服务于临床,使患者受益。为临床推广提供科学依据。方法:中文数据库检索CNKI、万方、Sinomed等,同时英文检索Pubmed、Embase、Web of science等数据库,纳入治疗卒中后失眠的...目的:探讨针灸疗法治疗卒中后失眠的有效性和安全性,以更好的服务于临床,使患者受益。为临床推广提供科学依据。方法:中文数据库检索CNKI、万方、Sinomed等,同时英文检索Pubmed、Embase、Web of science等数据库,纳入治疗卒中后失眠的随机对照试验(randomized control trials, RCTs)中使用单纯针灸对比单用西药干预方案的研究,用Cochrane评价方法进行风险偏倚评估,收集纳入研究的有效率、痊愈率、PQSI评分、肢体功能评分、中医症候评分、焦虑抑郁评分、不良反应与远期随访等资料,并进行Meta分析。分类和连续型变量分别用相对危险度(RR)和加权均数差(WMD)为合并效应量。结果:本研究共纳入34篇RCTs,总例数2698例,治疗组1361例,对照组1337例。Meta分析结果显示:与其西药相比,针灸可提高46%的临床有效率和75%的临床痊愈率,合并效应量RR=1.46, 95%CI[1.27, 1.68],P<0.01,RR=1.75, 95%CI[1.52,2.03],P<0.01。单独分析高质量文献结果与前结果意义一致。但针灸在改善肢体功能评分、中医症候评分和焦虑抑郁评分方面,与单纯西药对比,差异不明显,结果无统计学意义。在不良反应测评,单纯针灸相关疗法组的不良事件发生率(6%)明显低于以西药治疗(39%),安全性较好。但远期疗效随访上根据分析,单纯针灸治疗在1个月与3个月随访时PQSI评分并不优于单纯西药治疗。结论:针灸治疗卒中后失眠临床疗效优于西药,有更好的疗效和安全性,适合临床推广使用,但在改善症候、肢体功能和远期疗效上仍有待验证,且纳入文献数目较少,质量较低,需要高质量的大样本双盲随机对照试验的支持。展开更多
The needling sensation of Deqi during acupuncture is a key factor of influencing acupuncture outcome.Recent studies have mainly focused on the brain function effects of Deqi in a physiological state.Functional magneti...The needling sensation of Deqi during acupuncture is a key factor of influencing acupuncture outcome.Recent studies have mainly focused on the brain function effects of Deqi in a physiological state.Functional magnetic resonance imaging（f MRI）on the effects of acupuncture at Waiguan（SJ5）in pathological and physiological states is controversial.In this study,12 patients with ischemic stroke received acupuncture at Waiguan（SJ5）and simultaneously underwent f MRI scanning of the brain,with imaging data of the activated areas obtained.Based on the patient＇s sensation,imaging data were allocated to either the Deqi group or non-Deqi group.In the Deqi group,the activated/deactivated areas were the left superior temporal gyrus（BA39）/right anterior lobe of the cerebellum and left thalamus.In the non-Deqi group,the activated areas included the medial frontal gyrus of the right frontal lobe（BA11）,right limbic lobe（BA30,35）,and left frontal lobe（BA47）,while the only deactivated area was the right parietal lobe（BA40）.Compared with the non-Deqi group,the Deqi group exhibited marked activation of the right anterior lobe of the cerebellum and right limbic lobe（BA30）.These findings confirm that the clinical effect of Deqi during acupuncture is based on brain functional changes.Cerebellar activation may be one of the central mechanisms of acupuncture in the treatment of ischemic stroke.展开更多
The basic concept of integrative medicine（IM） is that by combining mainstream（biomedicine） with complementary and alternative medicine（CAM）, synergistic therapeutic effects can be attained.When the methods of mi...The basic concept of integrative medicine（IM） is that by combining mainstream（biomedicine） with complementary and alternative medicine（CAM）, synergistic therapeutic effects can be attained.When the methods of mind/body medicine（MBM） are added to this combination,as in Western countries,a new concept emerges that drastically changes the approach toward illness. It is interesting to note that the joining of traditional Chinese medicine and Western medicine in the early days of the Peoples＇ Republic of China preceded the Western model of IM by almost 50 years.Several elements that make up the key components of IM as practiced today in the West were already present in the Chinese version of IM,and Chinese medicine has played and continues to play an important role in advancing IM.However,one of the major differences between the Chinese and the Western models of IM today,besides MBM and some other treatment options,is that Western integrative medicine（WIM） strictly requires its CAM methods to be supported by scientific evidence. The therapeutic methods of IM and their applications are many and varied.However,they are most frequently employed to treat chronic medical conditions,e.g.,bronchial asthma,rheumatic disease, chronic inflammatory bowel disorder and chronic pain.Other fields in which IM may be applied are internal medicine（inflammatory bowel diseases and cardiovascular diseases）,musculoskeletal disorders,oncology （chemotherapy-induced side effects）,obstetrics and gynecology（dysmenorrhea,endometriosis,infertility and menopausal complaints）,pediatrics,geriatrics,neurology（migraine and chronic headache）,and psychiatry （anxiety and depression）. The concept of WIM is discussed here in detail by reviewing its scope and implications for the practice of medicine and focusing on the role of Chinese medicine in WIM.展开更多
文摘目的:探讨针灸疗法治疗卒中后失眠的有效性和安全性,以更好的服务于临床,使患者受益。为临床推广提供科学依据。方法:中文数据库检索CNKI、万方、Sinomed等,同时英文检索Pubmed、Embase、Web of science等数据库,纳入治疗卒中后失眠的随机对照试验(randomized control trials, RCTs)中使用单纯针灸对比单用西药干预方案的研究,用Cochrane评价方法进行风险偏倚评估,收集纳入研究的有效率、痊愈率、PQSI评分、肢体功能评分、中医症候评分、焦虑抑郁评分、不良反应与远期随访等资料,并进行Meta分析。分类和连续型变量分别用相对危险度(RR)和加权均数差(WMD)为合并效应量。结果:本研究共纳入34篇RCTs,总例数2698例,治疗组1361例,对照组1337例。Meta分析结果显示:与其西药相比,针灸可提高46%的临床有效率和75%的临床痊愈率,合并效应量RR=1.46, 95%CI[1.27, 1.68],P<0.01,RR=1.75, 95%CI[1.52,2.03],P<0.01。单独分析高质量文献结果与前结果意义一致。但针灸在改善肢体功能评分、中医症候评分和焦虑抑郁评分方面,与单纯西药对比,差异不明显,结果无统计学意义。在不良反应测评,单纯针灸相关疗法组的不良事件发生率(6%)明显低于以西药治疗(39%),安全性较好。但远期疗效随访上根据分析,单纯针灸治疗在1个月与3个月随访时PQSI评分并不优于单纯西药治疗。结论:针灸治疗卒中后失眠临床疗效优于西药,有更好的疗效和安全性,适合临床推广使用,但在改善症候、肢体功能和远期疗效上仍有待验证,且纳入文献数目较少,质量较低,需要高质量的大样本双盲随机对照试验的支持。
基金supported by the National Key Basic Research and Development Plan of China(973 Program),No.2006CB504505,2012CB518504the"University Students Innovation Experiment Project"in Guangdong Province of China,No.1212112038
文摘The needling sensation of Deqi during acupuncture is a key factor of influencing acupuncture outcome.Recent studies have mainly focused on the brain function effects of Deqi in a physiological state.Functional magnetic resonance imaging（f MRI）on the effects of acupuncture at Waiguan（SJ5）in pathological and physiological states is controversial.In this study,12 patients with ischemic stroke received acupuncture at Waiguan（SJ5）and simultaneously underwent f MRI scanning of the brain,with imaging data of the activated areas obtained.Based on the patient＇s sensation,imaging data were allocated to either the Deqi group or non-Deqi group.In the Deqi group,the activated/deactivated areas were the left superior temporal gyrus（BA39）/right anterior lobe of the cerebellum and left thalamus.In the non-Deqi group,the activated areas included the medial frontal gyrus of the right frontal lobe（BA11）,right limbic lobe（BA30,35）,and left frontal lobe（BA47）,while the only deactivated area was the right parietal lobe（BA40）.Compared with the non-Deqi group,the Deqi group exhibited marked activation of the right anterior lobe of the cerebellum and right limbic lobe（BA30）.These findings confirm that the clinical effect of Deqi during acupuncture is based on brain functional changes.Cerebellar activation may be one of the central mechanisms of acupuncture in the treatment of ischemic stroke.
文摘The basic concept of integrative medicine（IM） is that by combining mainstream（biomedicine） with complementary and alternative medicine（CAM）, synergistic therapeutic effects can be attained.When the methods of mind/body medicine（MBM） are added to this combination,as in Western countries,a new concept emerges that drastically changes the approach toward illness. It is interesting to note that the joining of traditional Chinese medicine and Western medicine in the early days of the Peoples＇ Republic of China preceded the Western model of IM by almost 50 years.Several elements that make up the key components of IM as practiced today in the West were already present in the Chinese version of IM,and Chinese medicine has played and continues to play an important role in advancing IM.However,one of the major differences between the Chinese and the Western models of IM today,besides MBM and some other treatment options,is that Western integrative medicine（WIM） strictly requires its CAM methods to be supported by scientific evidence. The therapeutic methods of IM and their applications are many and varied.However,they are most frequently employed to treat chronic medical conditions,e.g.,bronchial asthma,rheumatic disease, chronic inflammatory bowel disorder and chronic pain.Other fields in which IM may be applied are internal medicine（inflammatory bowel diseases and cardiovascular diseases）,musculoskeletal disorders,oncology （chemotherapy-induced side effects）,obstetrics and gynecology（dysmenorrhea,endometriosis,infertility and menopausal complaints）,pediatrics,geriatrics,neurology（migraine and chronic headache）,and psychiatry （anxiety and depression）. The concept of WIM is discussed here in detail by reviewing its scope and implications for the practice of medicine and focusing on the role of Chinese medicine in WIM.
