UMAB Unione Medici Agopuntori Bresciani GSATN Scuola

Transcription

UMAB Unione Medici Agopuntori Bresciani
GSATN Scuola Italiana di Agopuntura e Medicine Complementari.
Tesi compilativa di auriculoterapia anno accademico 2009-2010
Titolo:”Metodologia dell’EBM in agopuntura e medicine
complementari.
Applicazione dell’Auriculoterapia nei più comuni disturbi
dell’apparato digerente:nausea e vomito,stipsi e diarrea,malattie
infiammatorie,discinesie delle vie biliari.
Dr Osvaldo Angelini
Relatore –tutore dr Sergio Perini
Struttura e contenuti dei capitoli
A tale scopo sarà fatta una ricerca bibliografica periodo 2000-2005.
Fonti e dati di informazioni:siti web,abstract di articoli,manuali e
trattati di auriculoterapia.
-Ricerca di fonti on line circa trials clinici secondo EBM e
segnalazione di siti per la medicina complementare ed
alternativa(CAM in lingua anglosassone).
-Evidenze delle aree auricolari di interesse gastroenterologico.
-Descrizione delle mappe francese e cinese ,loro discrepanze e
possibile spiegazione delle diversità.
-Descrizione dei meccanismi fisiopatologici nella auriculoterpia delle
più comuni sindromi dell’apparato gastroenterico(nausea e
vomito,dispepsia,discinesie e calcolosi delle via biliari,stipsi/diarrea
e colon irritabile,malattie infiammatorie cr.
-Conclusioni
Disamina sintetica del materiale bibliografico e dei lavori
clinici per rispondere alla domande della introduzione e
della premessa.
Bibliografia esemplficativa riportata nella tesi,ed in ordine
di interesse:
-siti web da consultare;
-allegati vari: tabelle,schede legislative ecc.
Premessa
La compilazione della tesi parte dagli interessi professionali
specialistici del compilatore,specialista in malattie dell’apparato
gastroenterico ed endoscopia,il quale ha rilevato, partendo da
una inchiesta del dottor M. Romoli, autore del manuale di
“Agopuntura Auricolare”ed. UTET ,una scarsa applicazione della
metodica nei disturbi dell’apparato digerente.
Infatti i cultori della materia , alla domanda “Per quali patologie la
usi più spesso?”rispondevano ,sommando 203 patologie diverse,
-area del dolore prevalentemente di tipo muscolo scheletrico
55,6%;
-sfera dei disturbi psichici 36,4%;
-disturbi da dipendenza (compresi disturbi del comportamento
alimentare) 21,7%;
-sindromi cefalalgiche 8,9%;
-disturbi ginecologici e dermatologici(allergia compresa) 4,9%.
“Qual è la patologia che ti ha dato maggiore soddisfazione o il
miglior risultato?” gli intervistati hanno indicato 148 sintomi con
una frequenza di:
-dolore muscolo scheletrico 21,6%;
-ansia 15,5%;
-lombalgia/lombo sciatalgia 12,2 %;
-tabagismo 10,1%;
-cervicoalgia 9,4%;
-cefalea tensiva /emicrania 4,7%;
-disturbi del ciclo mestruale e del climaterio 4,0%;
-depressione ed altri disturbi psichici 3,4%;
-insonnia 2,0%;
-nevralgie trigeminali 2,0%;
-iperemesi 2,0%;
-altre patologie 6,3% ed un totale di 100%.
Introduzione
Dalla considerazione statistica che circa il 10% dei
ricoveri acuti in regime ordinario in termini di
MDC(categorie diagnostiche maggiori)riguarda
sintomi e malattie dell’apparato digerente , si vuole
indagare il possibile ruolo dell’Auriculoterapia e della
sua efficacia ed efficienza nella gestione del
paziente.
Ricoveri per acuti in regime ordinario
Nel 2002 si sono svolti in modalità ordinaria circa 8.879.000 ricoveri ed oltre 59.451.000 giornate di
degenza. L'85,1% dei ricoveri ha una durata di degenza compresa tra 2 giorni ed il valore soglia. La
percentuale di casi con durata della degenza oltre il valore soglia è molto bassa in tutte le Regioni, con un
valore medio dell'1,3%.
In termini di MDC (categorie diagnostiche maggiori), la maggior quota di dimissioni dai reparti di
assistenza per acuti nell'anno 2002 è riferita alle malattie dell'apparato cardiocircolatorio (14,1%),
malattie del sistema muscolo-scheletrico e del tessuto connettivo (11,8%), malattie dell'apparato
digerente (10,5 ), gravidanza, parto e puerperio (8,6%), malattie del sistema nervoso (7,5 %).
La distribuzione della casistica per MDC rilevata nel 2002 è sovrapponibile a quella registrata negli anni
precedenti. La riduzione del numero di dimissioni tra i ricoveri per acuti in regime ordinario riguarda quasi
tutte le MDC, ed in particolare le malattie dell’occhio, le malattie dell’orecchio, del naso, della bocca e
della gola, le malattie dell’apparato digerente e le malattie della pelle, del tessuto sottocutaneo e della
mammella.
Un incremento di oltre 20.000 casi si registra invece nelle malattie dell’apparato respiratorio e di 7.000
nelle malattie infettive e parassitarie. Per un’analisi di maggiore dettaglio di ciascuno dei 489 DRG, viene
riportato un prospetto analitico con la numerosità dei casi trattati e delle giornate di degenza, la degenza
media e la degenza media "entro il valore soglia", il valore soglia.
E’, inoltre, riportata la distribuzione dei casi per durata della degenza, utilizzando una classificazione
legata alle modalità di remunerazione delle prestazioni ospedaliere previste dal D.M. 30.6.1997 e alle
specifiche necessità di controllo dei ricoveri con durata breve (2-3 giorni).
Da tale prospetto, riferito ai ricoveri ordinari, è escluso il DRG 391, relativo ai neonati normali, che viene
analizzato separatamente in un settore ad hoc del rapporto. Allo scopo di evidenziare la casistica
prevalente, in termini di numerosità dei casi trattati negli istituti di cura, sono anche riportati, in ordine
decrescente di frequenza, i 60 DRG, medici e chirurgici, con maggiore numerosità delle dimissioni; per
questo gruppo di DRG la frequenza cumulativa sul totale dei casi raggiunge il 51,6% in termini di
dimissioni ed il 45,3% in termini di giornate di degenza.
In termini di posizioni tra i DRG più frequenti (rango) viene confermata parzialmente, la composizione
della casistica osservata negli anni precedenti.
Graduatoria dei primi 10 DRG – anni 2001-2002
DRG
1) 373 Parto vaginale senza diagnosi complicanti
2002
2001 Posizione
321.698 322.962
1)
2) 127 Insufficienza cardiaca e shock
3) 039 Interventi sul cristallino con o senza
vitrectomia
4) 371 Parto cesareo senza complicazioni
5) 183 Esofagite, gastroenterite e misc. mal.app.
dig. età >17 anni senza CC
6) 410 Chemioterapia non associata a diagnosi
secondaria di leucemia acuta
7) 014 Mal. cerebrovascolari specifiche eccetto
attacco ischemico transitorio
8) 359 Interventi su utero e annessi non per
neoplasie maligne, senza CC
9) 088 Malattia polmonare cronica ostruttiva
10) 222 Interventi sul ginocchio senza CC
186.291 177.276
3)
173.085 229.316
2)
156.906 160.440
5)
130.570 176.610
4)
122.785 129.938
6)
119.158 118.730
8)
111.453 116.911
9)
111.363 112.739
110.314 113.958
11)
10)
Dai dati illustrati sorgono alcune domande circa l’Agopuntura
auricolare
1) le evidenze scientifiche di trials clinici confermano o escludono la
sua efficacia?;
2) è efficace nei più comuni sintomi dispepsia,stipsi,diarrea,colon
irritabile ?;
3)le discrepanze teoriche tra la mappa francese e quella cinese
possono impedire una corretta informazione per la terapia di tali
disturbi.
Capitolo I
-Ricerca di fonti on line circa trials clinici secondo EBM e
segnalazione di siti per la medicina complementare ed
alternativa(CAM in lingua anglosassone).
Il grafico presenta le percentuali delle varie branche terapeutiche
della medicina complementare alternativa ponendo in generale
l’agopuntura al 53 % dei trattamenti.
Raccomandazioni per migliorare la sintesi dei lavori scientifici di
medicina complementare ed alternativa (CAM) del NCAM
National Center for Complementary and alternative medicine.
1)Cercare database specializzati in CAM usando parole chiave
estensive e impiego di metodi come ricerca manuale,liste di
referenze significative,contatti con esperti della branca.
2)Utilizzo di report di lingua non inglese per particolari lavori di
CAM.
3)Considerare se la terapia della CAM possa essere adeguata e
compatibile con uno studio di confronto con il placebo ed in
doppio cieco;se lo studio è adeguato usare criteri di validità
statistici.
4)Se la terapia CAM non è adeguata ad uno studio-controllo con
placebo,occorre considerare se una appropriata procedura sham
può essere inclusa.
5)Prevedere in maniera esplicita eventuali e rari eventi avversi.
6)Considerare i dati osservazionali degli eventi avversi come
limite di tali dati per il completamento del lavoro.
Fonti on line da consultare.
-EMBASE
-MEDLINE
-NATURALPRODUCTS ALERT(napralert)
-ALLIED AND ALTERNATIVE MEDICINE (AMED).
L’uso della medicina compementare ed alternativa (CAM) continua a crescere negli Stati
Uniti d’ America . L’Agenzia for Healthcare Research and Quality ha stabilito una
sostanziale parte del programma dell’Evidence-based Practice Center (EPC) alle
revisioni sistematiche della medicina CAM. Tali sintesi sistematiche presentano
differenti modalità rispetto alla medicina occidentale e sono stati , pertanto , identificati
tre obiettivi da indagare :
- identificare l’evidenza circa la CAM,
- affermare la qualità di studi individuali,
- individuare rari e seri effetti collaterali.
Identificare l’evidence nella letteratura CAM.
I molti errori nella pubblicazione e nell’indicizzazione della letteratura CAM pone un
problema di classificazione.
Publication bias (errori di pubblicazione ) si riferiscono alla tendenza dei ricercatori ,
dei revisori , e degli editori a rifiutare o accettare lavori in base alla evidenza o alla
direzione dei risultati.
Mentre l’errore di pubblicazione (publication bias) è considerato nella ricerca della
medicina convenzionale , nella ricerca CAM tale punto è particolarmente complicato.
Molti studi CAM pubblicati in riviste del settore presentano risultati positivi.
Alcuni paesi come Cina, Giappone,Russia, e Taiwan pubblicano più studi con risultati
positivi piuttosto che studi con risultati negativi ; questo sbilanciamento potrebbe
riflettere un‖publication bias‖.
Errori di pubblicazione (Publication bias) lingua-correlati esistono anche nelle
pubblicazioni CAM come accade pure nei lavori della ricerca della medicina
convenzionale.
I dati negative della ricerca CAM tendono ad essere pubblicati di più nelle principali
riviste mediche (per esempio riviste di lingua inglese), mentre risultati positivi della
letteratura CAM tendono ad essere pubblicati in CAM riviste (che tendono ad essere non
di lingua inglese).
Invero l’esclusione di lavori in lingua non inglese potrebbe risultare in una esclusione di
efficacia di lavori con risultati positivi.
Studi circa terapia di CAM potrebbero inizialmente essere pubblicati solo in riviste
non di lingua inglese.
Nella medicina CAM pediatrica alcune evidenze suggeriscono che studi clinici
randomizzati e gruppi di controllo (RCTs) tendono ad essere pubblicati in lingua
inglese e spesso sulle principali riviste mediche.
Un altro errore che limita l’accesso è l’incompleto o improprio indexing delle riviste e
articoli CAM da parte dei principali database come ad esempio MEDLINE .
Per esempio MEDLINE indicizza solo il 10% delle riviste CAM identificate in tutto il
mondo dal National Center for Complementary and Alternative Medicine e dalla
National Library of Medicine , mentre approssimativamente il 35% di tutte le riviste
biomediche pubblicate in tutto il mondo sono indicizzate in MEDLINE .
L’inconsistente uso di parole chiave ,descrizione e oggetto della ricerca,solo con
differenti processi di indicizzazione nei database ,potrebbero porre problemi
nell’allocazione della letteratura CAM.
L’inconsistenza della terminologia potrebbe in parte spiegare perché una ricerca
MEDLINE del termine alternative medicine non riprende tutti gli studi rilevanti nel
campo della medicina .
Per tutti i reports gli investigatori hanno cercato database specializzati in CAM in
aggiunta ai principali database.
Almeno dieci database :
1) Alternative medicine d and Complementary Medicine Database (AMED);
2) Cochrane Complementary Medicine Trials Registry;
3) Alt Health Watch;
4) Manual, Alternative and Natural Therapy Index System (MANTIS);
5) Natural Products Alert (NAPRALERT);
6) International Bibliographic Information on Dietary Supplements (IBIDS);
7) Home-Inform; The Arthritis and Complementary Medicine Database (ARCAM);
8) Arthritis Rheumatoide and Complementary and Alternative Medicine and Pain
Database (CAMPAIN).
Molti sono accessibili liberamente .
La strategia di ricerca usata per molti articoli non comprende restrizioni lingua –inglese
correlate.
Per la maggior parte dei lavori ,i ricercatori includono una lista estesa di parole chiave
per identificare articoli che potrebbero non essere indicizzati da argomenti standard
principali, o per i quali la terminologia era inconsistente .
Solo pochi ricercatori usano la ricerca per soggetto principale.
La ricerca di letteratura grigia è un altro metodo per identificare in più della metà dei
casi errore di pubblicazione.
Molti ricercatori hanno specificato di aver identificato mediante revisione articoli
erroneamente indicizzati dai principali database.
I ricercatori devono essere attenti alla possibilità di errore di citazione perché gli
articoli con risultati positivi sono citati più frequentemente.
L’errore di citare solo i lavori con risultati positivi è molto frequente nella ricerca della
medicina occidentale ma lo è ancora più accentuato nella medicina CAM.
Al contrario intervistando altri ricercatori generalmente si afferma che i lavori con
risultati negativi sono meno pubblicati.
I lavori della medicina CAM presentano ampia variabilità nel disegno e nell’ esecuzione
dello studio rispetto alla validità e alla riproducibilità.
Questi problemi sono collegati al problema della spiegazione esatta del tipo di
intervento affinché altri possano riprodurlo e che possa essere applicato dai praticanti la
CAM.; questi problemi riguardano l’errore di aspettativa (l’effetto sistematico sui
risultati positivi dei partecipanti che hanno una aspettativa positiva da una certa terapia).
La maggior parte dei lavori CAM sono indagati dopo un loro estensivo uso ed a tal
punto che non possono essere ignorati ed allo stesso tempo l’uso sistematico può essere
inficiato da esperienza personale,errori ed aspettative.
Per molte terapie CAM talvolta è richiesta una interazione concettuale tra ricercatore e
paziente che modifica la terapia nell’individuo.
La MTC e l’agopuntura , la manipolazione vertebrale, e la medicina ayurvedica e la
chiroterapia richiedono una individualizzazione della terapia basata sull’esame del
paziente e delle sue condizioni usando concetti che non hanno corrispettivi nella
medicina occidentale allopatica.
Frequentemente però trials pragmatici sono fatti nella medicina CAM legati piuttosto
alla abilità dei singoli medici ed ai pazienti non viene assegnata terapia che poi possa
essere riprodotta da altri ricercatori.
I ricercatori della medicina CAM eseguono trattamenti individuando la terapia per
ciascun particolare paziente.
Questo rende quasi nascosto e difficile da controllare l’errore da aspettativa e difficile da
riprodurre da parte di altri ricercatori.
Invero i trials pragmatici dovrebbero mettere in discussione il training e l’esperienza
dei ricercatori.
La maniera tradizionale per controllare l’errore da aspettativa nei trials che sperimentano
farmaci è quello di confrontarlo con un placebo ed in doppio cieco.
La grandezza del potenziale ―risposta placebo‖ o persino la sua esistenza per tutti è
controversa. D’altronde c’è un accordo per cui la risposta placebo è particolarmente
importante in studi che utilizzano dati soggettivi del paziente come outcames
,specialmente nel dolore.
A motivo della sindrome dolorosa cronica per le quali una larga parte dei pazienti si
rivolge alla terapie della medicina CAM , l’utilizzo del controllo placebo è
particolarmente importante.
Alcune terapie della medicina CAM tipo erbe o supplementi dietetici possono essere
indagati con doppio controllo placebo, in doppio cieco .
Per altre terapie della medicina CAM il placebo ed il doppio cieco possono essere
particolarmente difficili da sfidare.
L’utilizzo di procedure sham , piuttosto che il placebo , è possibile quando la terapia
CAM possa essere valutata , se ben specificata.
Un meccanismo per stabilire il successo della ―cecità‖di una terapia sham è quello di
interrogare il paziente dopo aver ricevuto il trattamento e di chiedere di indovinare se ha
ricevuto una terapia vera ed efficace o la terapia sham.
Risposte simili nel paziente che riceve terapia attiva e quella sham sono una buona
evidenza che la terapia sham ha buone capacità di controllare l’errore di aspettativa.
Terapie sham efficacy sono state riportate nei lavori di agopuntura e di manipolazione
vertebrale.
Mentre non è possibile il doppio cieco dei pazienti e dei ricercatori nei trials pragmatici
,è possibile usare outcomes da verificare in cieco rispetto al trattamento ricevuto.
Se possibile l’utilizzo di tale modalità ,essa dovrebbe essere considerata una validità di
metodologia.
In conclusione ,questa variabilità nella terapia negli studi si presenta come una sfida per
le revisioni sistematiche.
Se i gruppi sham stimolano prudenza in importanti condizioni,esse non possono essere
equiparate e trattate come generico gruppo di controllo nelle revisioni narrative o metaanalisi.
I ricercatori devono esaminare il trattamento sham in maniera approfondita cosi come
sono stabiliti gruppi attivi di controllo.
Categorie di controllo di sham terapia possono avere necessità di essere costruite ed ogni
studio di essere classificato.
Questa categorizzazione può comportare una perdita del numero campione ,dal
momento che sempre pochi studi saranno paragonabili.
I ricercatori dovrebbero considerare di scegliere il trattamento attivo di interesse come
gruppo di riferimento ,ad esempio manipolazione vertebrale ,e successivamente creare
gruppi adeguati di numero di altre terapie alternative versus il gruppo di riferimento.
Ricerca di potenziali e rari fatali eventi avversi.
Sebbene la maggior parte delle terapie della medicina CAM siano ritenute sicure
,rimane ancora il problema di come stabilire e quantificare la possibilità di eventi rari
e fatali.
Due esempi illustrano il problema ; effetti devastanti legati alla chiroterapia utilizzata
da dieci milioni di pazienti/per anno negli Stati Uniti e l’uso di erba efedra .
Poiché nei RCT della medicina CAM sono riportati poche e fatali reazioni avverse
occorre aumentate l’intervallo di confidenza da 0,18 a 1 ma questo comporta
l’arruolamento di soggetti in gran numero ed improbabile nella realtà (circa 3 milioni
di soggetti da arruolare).
Con dati dei RCT insufficienti a trarre conclusioni, una ipotesi per l’evidenza è l’ipotesi
–tesi di studi osservazionali .
Lo studio case–control è un mezzo epidemiologico tradizionale per valutare
possibile relazione fra esposizione ed eventi rari ,come una relazione tra fumo e
cancro del polmone o tra fenilpropanolamina e stroke.
Sfortunatamente la maggior parte delle terapie della medicina CAM non sono state
sottoposte a studi di case control.
Una terza possibilità di evidenza è la creazione di grandi registri di persone che
hanno ricevuto tali pratiche.
La sorveglianza postmarketing permette di rilevare effetti collaterali importanti come ad
esempio insufficienza epatica da farmaco antidiabetico (come nel caso del troglitazone).
L’altra strada è la possibilità di grandi registri amministrativi che permette facilmente di
stabilire una potenziale relazione tra il tipo di intervento e un outcome.
Questo sarebbe possibile se tutte le terapie della medicina CAM fossero rimborsati e
codificati in registri e data base amministrativi.
L’ultima modalità di evidenza è il case report .
Però ci sono delle limitazioni quali la non accessibilità a tutti i casi negativi,la non
completezza dei dati e infine non sufficienti a stabilire una diretta causalità ma viene
considerata dalla FDA plausibilità biologica.
I RCT sono la migliore maniera di stabilire la casualità ,ma non si hanno mai studi con
sufficiente numero di pazienti per stabilire un rischio di un evento maggiore di 1 a 1000.
Case–control o studi di cohorte possono essere ricercati ma sono molto rari.
La decisione di includere case report deve essere presa caso .
In aggiunta i revisori di studi clinici dovrebbero prestare attenzione quando i criteri di
inclusione ed esclusione per un trial includono una valutazione medica.
Tale valutazione dovrebbe identificare ed escludere soggetti ad aumentato rischio per
eventi avversi.
A proposito di CAM ® su PubMed
NCCAM e la National Library of Medicine (NLM) hanno collaborato
per creare CAM su PubMed ®, è un sottoinsieme della NLM
PubMed. PubMed permette di accedere a database di citazioni da
MEDLINE ed altre riviste di scienze della vita. Esso include anche
link a molti articoli full-text a riviste siti web e altre risorse web.
Si segnalano i maggiori siti bibliografici dell’Europa,dell’Asia e degli Stati Uniti
circa la medicina complementare ed alternativa,destinati a facilitare la
conoscenza al pubblico ed agli esperti del settore.
Essi segnalano revisioni cliniche,biomediche ,o ricerche di meta analisi.
Criteri per la selezione
Contents: Classification of Databases
1. Major Structured Biomedical Bibliographic Databases
2. Main Databases specific to Alternative and Complementary Medicine
3. Medical, Pharmaceutical or Scientific Bibliographic Databases
4. Traditional Medicine Databases
5. Therapy or Modality-Specific Bibliographic Databases
6. Clinical Trial and Research Project Databases
1. Major Biomedical Bibliographic Databases
The major bibliographic databases that offer comprehensive coverage of biomedical research literature also
contain a significant number of citations on alternative and complementary medicine information. These
databases index a relatively small but growing number of alternative medicine journals but generally have a
policy of indexing the entire contents of the predominantly peer-review journals they include. So, as
increasing numbers of articles on alternative medicine are published in mainstream journals, they are being
indexed. There is partial overlap in the alternative medicine subsets of these databases.
Database
Fee
Access
or
Information
Free
PubMed
PubMed has become the predominant means of accessing MEDLINE, the world's largest
single biomedical database, produced by the National Library of Medicine (NLM), USA.
Free
Approximately 5,000 journals in 37 languages are indexed and the over 15 million references
go back to 1950. Indexing keywords are known as MeSH terms.
Embase
Produced by Elsevier Science BV, The Netherlands, Embase has extensive coverage of
Fee
pharmacological as well as biomedical research. Embase.com allows online searching of the
Emabase database along with selected MEDLINE records.
ISI Web of Science - now Thomson Scientific
Fee
Public web
access
Subscription
based online
access
Subscription
Science Citation Index and Social Science Citation Index
These two databases are now part of Thomson Scientific providing access to current and
retrospective bibliographic information, author abstracts, and cited references from the
world's leading scholarly science, social science, and technical journals worldwide.
based online
access
[Back to list]
2. Main Databases specific to Complementary and AlternativeMedicine (CAM)
Fee
or
Access Information
Free
AMED (Allied and Complementary Medicine Database)
CD, Online library
Produced by the British Library Health Care Info. Service, this database contains
services, or individual
Fee
primarily European references, much of which is not found in MEDLINE or
subscription. Search
EMBASE.
service available
CAM on PubMed
NCCAM and the National Library of Medicine (NLM) partnered to create a
Complementary and Alternative Medicine subset of NLM's PubMed, providing
access to relevant citations from the MEDLINE database and additional life
Free Public web access
science journals. To access, go to PubMed and click on the "Limit" function.
From the Subsets pull down menu, select "Complementary Medicine" and then
search from within this subset.
Cochrane Collaboration, Complementary Field
Abstracts and new
This international alliance of researchers maintains and updates a registry of
protocols available as
randomized controlled trials. The Complementary Medicine Field is based at the Free
pdf file on the CMP
University of Maryland. See the Abstracts of systematic reviews related to
website
complementary and alternative medicine.
CAMPAIN Complementary and Alternative Medicine and Pain
Database compiled from relectronic and hand searches of scientific literature
sources world-wide, maintained by theUniversity of Maryland, Center for
Integrative Medicine.
DATADIWAN
The German, Patienteninformation fur Naturheilkunde, (Patient information for
natural therapies) has a searchable database on line, much of it in English,
Publicly available on
Free
providing information on holistic medicine and a network linking research
DATADIWAN website
institutions and organizations worldwide. There are over 6,000 bibliographic
entries and 6,000 addresses.
Database
[Back to list]
3. Medical, Pharmaceutical or Scientific Bibliographic Databases
The following databases also contain a considerable number of references on alternative and
complementary medicine:
Database
Fee
or
Access Information
Free
AGRICOLA
AGRICultural OnLine Access is a bibliographic database created by
the National Agriculatural Library, USA, and contains citations on
medicinal plants.
CABI - CAB ABSTRACTS
Bibliographic database from UK, covers agriculture, forestry, aspects
of human health, nutrition, and management and conservation of
natural resources.
CINAHL
Cumulative Index to Nursing and Allied Health covers primarily
nursing journals and includes CAM citations.
NAPRALERT
Relational database, from University of Illinois, of worldwide literature
on natural products: ethnomedical, pharmacological/biochemical,
clinical studies. Similar information is available for secondary
metabolites.
NLM Databases
Provides access to many useful databases, including ToxNet and
ClinicalTrials.gov. Bioethics, Cancer Information, and HIV/AIDS can
be accessed from PubMed. To access, go to PubMed and click on
the "Limit" function. From the Subsets pull down menu, select the
subset.
PsycINFO
Psychological abstracts from 1800s to present includes mind-body
and other CAM information.
Fee
Print and electronic access
Fee
Access through Ovid library service
Fee
Web-based interface provides
access to specific reports,
generated from queries. Payment is
by credit card at time of search,
based on number of citations.
Fee
Online search service for
individuals or institutions
[Back to list]
4. Traditional Systems of Medicine Databases
Database
African Health Anthology
A bibliographic reference resource that incorporates several Indigenous African
medicine Databases
American Indian Ethnobotany Database
Dr. Moerman's database of Foods, Drugs, Dyes and Fibers of Native American
Peoples, derived from plants is based at the University of Michigan
China TCM Patent Database
Established by the State Intellectual Property Office (SIPO) of People's Republic of
China, the English language section containsa subset of formulas from 1985 to
present.
FRLHT - Bio-Informatics on Medicinal Plants and Traditional Knowledge
Based in India, the Foundation for Revitalisation of Local Health Traditions has
compiled a comprehensive database of 7,500 botanical names. The primary purpose
of FRLHT is to preserve and revitalise local knowledge of plants and their uses.
JICST-EPlus
Comprehensive bibliographic database with English citations and abstracts, covering
Japanese literature on science, technology, and medicine from 1985
TCM Database System
A series of databases of traditional Chinese medicine, set up by the Institute of
Information on Traditional Chinese Medicine, China Academy of Traditional Chinese
Medicine, comprises 10 Chinese databases and 2 English, including TCMLARS
(Traditional Chinese Medlical Literature Analysis and Retrieval System) and
TCDBASE (Traditional Chinese Drug Database). Uses a common search strategy.
TEK*PAD
Traditional Ecological Knowledge*Prior Arts Database is an index and search engine
Fee
Access
or
Information
Free
Fee
CD-Rom format
Free
Web search
interface
Free
Web search
interface
Fee
No public access.
Searches may be
requested
Fee
Subscription
access information
on Web site
Fee
Web or CD
Free
Web search
interface
of existing Internet-based, public domain documentation concerning indigenous
knowledge and plant species uses, maintained by the American Association for the
Advancement of Science.
TradiMed
Built by the Natural Product Research Institute at Seoul National University, Korea,
from Chinese and Korean medical classics,TradiMed represents a combination of
traditional medicine knowledge and modern science Medicine, Seoul.
Fee
Individual
subscription
access via Web
[Back to list]
5. Therapy or Modality-Specific Bibliographic Databases or Search Services
Database
ACUBASE
An acupuncture and TCM practice management tool and a modifiable reference library.
Acubriefs
Searchable database with over 16,000 citations, many with online links to citation or
text, partly sponsored by the Medical Acupuncture Research Foundation
EthnobotDb
EthnobotDb is one of Dr. Duke's Phytochemical and Ethnobotanical Databases on the
US Agricultural Research Database covering ethnobotanical uses for plants.
HerbMed
An evidence-based herbal database providing hyperlinked access to the scientific
research on herbs, categorized and summarized, with dynamic updating. A project of
the Alternative Medicine Foundation. A professional version, HerbMedPro, is available
for licensing and subscription. See public website for details on how to apply.
HOM-INFORM
This database contains over 25,000 articles and book references on homeopathy,
compiled by the Glasgow Homoeopathic Hospital, UK, library service, Hom-Inform, is
an individualised search, query and document supply service available to all.
IBIDS
The database, International Bibliographic Information on Dietary Supplements, from the
Office of Dietary Supplements, NIH, covers vitamins, minerals, and herbs.
MANTIS
The database, updated monthly, mainly covers chiropractic literature, but includes
citations on osteopathy homeopathy, and manual medicine. Records are from over
1,000 journals from 1900 to present.
Qi Gong Database
2050 citations from varied sources on clinical and experimental research on Qigong.
Treuherz Collection
The private homeopathy reference library of Francis Treuherz holds 6,000 volumes.
Inquiries can be made through the Society of Homeopaths.
Fee
or
Free
Access
Information
Fee
CD format for PC
and Mac
Free
Web search
interface
Free
Web search
interface
Free
Browsable and
searchable on the
web
Free
and
fee
Free web
searching and fee
based services
Free
Searchable on the
web
Fee
Individual
subscription
access via Web.
Fee
CD format for PC
and Mac
Fee
CD format for PC
and Mac
See also the Botanical Core Research Resources for further information on herbal databases and
collections
[Back to list]
6. Clinical Trial and Research Project Databases
These listings are of interest to researchers, professionals and patients, providing active links to trials that
are currently recruiting.
Fee or
Database
Access Information
Free
AIDSinfo
Browsable and
AIDSinfo is a central resource for federally and privately funded clinical trials for Free
searchable on the web
AIDS patients and others infected with HIV.
Bandolier
Web search interface
Plain English summaries, from UK group, of evidence-based medicine published
Free and downloadable
research presented as searchable documents to provide advice about particular
documents
treatments or diseases for healthcare professionals and consumers.
CenterWatch
A searchable listing of over 4,100 industry and government-sponsored ongoing
Browsable and
Free
clinical trials categorized by therapeutic area and geographic region; useful
patient resource
ClinicalTrials.gov
Browsable and
Provides regularly updated information about federally and privately supported Free
clinical research using human volunteers.
Cochrane Library
The Cochrane Library consists of a collection of evidence-based medicine
Available as Web
Fee
databases, including The Cochrane Database of Systematic Reviews - updated
subscription or CD
quarterly. Abstracts are freely publicly search and browsable.
CRISP
This searchable database of NIH funded research and intramural research
Free Web search interface
projects contains mainly conventional biomedicine, but contains a growing
proportion of alternative medicine research pro jects and clinical trials.
iEdison
Interagency resource to helps government grantees and contractors comply with
a federal law, the Bayh-Dole Act, that requires that government funded
inventions be reported to the federal agency who made the award .
NCCAM Sponsored Research
This listing by year is not in database format but provides an overview of all
Free Browsable listing
extramural research sponsored by the National Center for Complementary
Medicine
USPTO
The US Patent and Trademark Office is an important and relatively unexplored
source of information and, often unpublished, research data relevant to studies
in alternative and complementary medicine.
[Back to list]
The information for this listing was researched and updated by Jackie Wootton, M.Ed, Informatics Project
Director 1995 to 2007.
The original categorized Directory of Databases was developed in collaboration with a group who first met in
Vienna, Austria in June 1994 at the Wiener Internationale Akademie fur Ganzheitsmedizin (The Vienna
International Academy for Integrated Medicine), and was co-funded by the Rosenthal Center for
Complementary and Alternative Medicine. This early pioneering project has inspired many similar
compilations, both electronic and paper publications.
Capitolo II
Definizione dell’auriculoterapia e sue applicazioni.
Auriculoterapia o agopuntura auricolare
L’agopuntura auricolare è un sistema esclusivamente terapeutico,
che consiste nell’infissione di piccoli aghi nelle orecchie. Le
metodiche più diffuse sono due: una di tipo energetico, che si
richiama sostanzialmente ai principi della medicina cinese, con
tutto il substrato filosofico-culturale che ne costituisce parte
integrante, un’altra che invece si richiama ai principi della
medicina convenzionale occidentale.
L’auriculoterapia che applica i principi della medicina cosiddetta
energetica ritiene che nell’orecchio vi siano i meridiani (non tutti
sono in accordo sul numero esatto, secondo alcuni vi terminano e
basta), che corrispondono agli organi della medicina cinese, e
quindi vengono stimolati secondo i medesimi principi diagnostici e
terapeutici della medicina tradizionale cinese.
L’auriculoterapia che si basa invece sui principi della medicina
convenzionale occidentale ritiene che a determinati punti
dell’orecchio corrispondano somatotopicamente altre aree del
corpo che possono essere lo stomaco, come la colonna vertebrale
o il fegato, e che mediante infissione di aghi o con altre
stimolazioni si possano provocare dei riflessi che inducono delle
stimolazioni di tipo neurogeno in organi e tessuti del corpo
umano.
In questa disciplina terapeutica, il concetto delle malattie rimane
il medesimo della medicina ufficiale, cambia solo il modo di fare
la terapia; pertanto le più comuni patologie quali per esempio la
gastrite, la calcolosi della colecisti o un tumore del pancreas sono
riconosciute con l’anamnesi , l’esame obiettivo e la semeiotica
della medicina ufficiale.
La terapia auricolare di tipo occidentale non ha implicazioni
energetiche-filosofiche ma ad esempio un agopunto utilizzato per
la nausea non varia secondo la personalità del paziente ,le sue
caratteristiche .
La ricerca dell’agopunto da stimolare varia con l’ispezione
diretta,con la pressione meccanica e con la misurazione della
differenza di resistenza con particolari apparecchi.
Alcune variazioni in questo tipo di tecnica sono quelle relative alla
ricerca dei cosiddetti agopunti in quanto secondo alcuni medici i
punti da stimolare devono essere cercati con appositi apparecchi
che misurano l’elettricità della pelle; secondo altri per la
stimolazione si possono usare vari tipi di aghi,la stimolazione con
deboli correnti elettriche oppure semplici semi di vaccaria o
magneti o la semplice stimolazione manuale.
Si può dire che l’auriculoterapia è basata sulla stimolazione di
aree precise della cute dell’orecchio per stimolare mediante
riflessi neurogeni organi e tessuti del corpo umano, basandosi
sempre però su diagnosi fatte secondo i canoni della medicina
convenzionale.
Quando è possibile rivolgersi all’auriculoterapia?
I punti auricolari hanno la caratteristica di essere in genere
percepibili solo quando sono la proiezione di uno stato patologico,
essendone la proiezione a distanza, e possono essere evidenziati
con la pressione diretta che provoca in tale sede un dolore
elettivo.
I punti che vengono stimolati sono in genere solo quelli che
corrispondono allo stato patologico in atto.
Per esempio, per un dolore alla spalla si stimolerà il punto
auricolare della spalla, situato nella doccia dell’antelice; ma si
possono fare anche associazioni di più punti se sono in stretto
rapporto con la patologia. Se, per esempio, un paziente soffre di
gastrite, ed è anche un soggetto ansioso, si tratteranno ambedue
i problemi. Le indicazioni sono numerose, in certi casi
l’auriculoterapia può essere risolutiva, mentre in altri può solo
ridurre la sintomatologia.
Per quanto riguarda le patologie disfunzionali dell’apparato
gastrointestinale, l’auriculoterapia si può rivelare utile nella
riduzione della stipsi secondaria alla somministrazione di
oppiacei, che spesso provocano un rallentamento significativo
della peristalsi gastro-intestinale: in questo caso la stimolazione
degli agopunti sull’orecchio è in grado di migliorare la digestione
e ridurre l’anoressia secondaria.
L’auriculoterapia può essere un valido aiuto anche contro la
nausea e il vomito provocati dalla chemioterapia; l’infissione di
pochi aghi nei soggetti sensibili può risultare molto utile nella
riduzione e scomparsa di questo tipo di disturbi senza necessità
di somministrare farmaci.
Infine, nel malato oncologico si può alleviare il dolore.
Occorre determinale l’esatta origine della sintomatologia
antalgica. Se infatti il dolore è provocato da una metastasi,
difficilmente il trattamento avrà un’efficacia significativa; se
invece il dolore ha origine da uno spasmo muscolare, ossia è
dovuto a patologie osteoarticolari che coinvolgono l’apparato
muscolo-scheletrico, oppure secondario a patologie della
muscolatura liscia, come quella del colon, si possono avere delle
risposte terapeutiche molto significative, in particolar modo per il
tipico mal di schiena vertebrale, che non di rado rende disabile il
paziente.
Spesso volte vi è una correlazione fra agopunto auricolare e regione
addominale interessato da patologia acuta come riportato nel lavoro
LIU Ji-hong,HE Xiu-zhen,LIU Zhao-hong,et al.(Foshan Municipal Hospital of Traditional Chinese Medicine,F
“Correlation auricular acupoint diagnosis with the affected
region of acute abdominalgia and Location diagnosis”
Differenza tra agopuntura auricolare e quella cinese
L’agopunura auricolare si distingue da quella cinese, non solo per
la modalità di infissione degli aghi, che nel primo caso è limitata
all’orecchio, mentre nel secondo segue i meridiani del corpo e
quindi gli agopunti che sono distribuiti su diverse aree della cute,
ma soprattutto perché nel caso dell’auricoloterapia è possibile
applicare, dopo una diagnosi eseguita secondo i canoni della
medicina ufficiale, una terapia riproducibile ed uguale per
ciascuna forma morbosa. Nella medicina cinese, le diagnosi sono
invece basate su concetti mai definitivamente dimostrati, ed in
cui la figura del medico è soprattutto una figura essenziale di
filtro tra i concetti diagnostici-terapeutici proposti dal sistema
medico-filosofico cinese e la diagnosi vera eseguita secondo le
modalità della medicina scientifica.
Yin e Yang
Tutto ciò che concerne la medicina cinese (sia l’agopuntura che la
fitoterapia) e la sua fisiologia, anatomia, patologia, diagnosi e
trattamento è riconducibile alla complessa teoria dello Yin e dello
Yang. Ogni processo fisiologico e patologico, ogni segno e
sintomo sono analizzati alla luce dello Yin e dello Yang.
Il primo riferimento allo Yin e Yang è verosimilmente contenuto
nel Libro dei Mutamenti, scritto attorno al 700 a.C. I concetti di
Yin-Yang e di Qi (energia) hanno permeato e permeano ancora il
pensiero cinese, rendendolo per diversi aspetti, nei suoi concetti
più intimi e fini, incomprensibile e intrinsecamente non
comparabile con il nostro modo di pensare e di agire.
Secondo questa concezione, per esempio, i concetti “il muro è
bianco” e “il muro non è bianco” non possono essere veri
contemporaneamente. Pensieri così semplici, che sono alla base
del pensiero europeo, e il concetto dei contrari e della loro
opposizione, base della filosofia aristotelica, matrice del nostro
pensiero, non sono concepibili secondo la filosofia cinese.
Infatti, il concetto di Yin e Yang rappresentano due caratteristiche
opposte ma presenti contemporaneamente in ogni cosa. Ogni
fenomeno, oggetto e soggetto materiale e immateriale, possono
essere se stesso e il suo contrario. Ed inoltre, lo Yin contiene la
radice dello Yang, e viceversa, e quindi contrariamente alla logica
filosofica europea, A non è automaticamente il contrario di non-A.
Mentre il nostro modo di pensare tende a creare dei confini ben
precisi e netti, quello cinese non ne ha bisogno, e anzi tende a
vedere, in ciò che noi consideriamo degli opposti, qualcosa che
ha una matrice in comune, mettendolo in relazione o in armonia
con il macrocosmo. Si ritiene che il concetto di Yin e Yang sia
probabilmente scaturito dal semplice alternarsi del giorno e della
notte, e quindi che l’origine di questa concezione si perda nella
notte dei tempi e negli archetipi di filosofia costituiti dalle
tradizioni sciamaniche. Il giorno infatti corrisponde allo Yang e la
notte allo Yin e, per estensione, l’attività allo Yang e il riposo allo
Yin; il cielo è lo Yang e la terra lo Yin, il cerchio è Yang e il
quadrato è Yin, e così via con una lunga teoria di concetti,
fenomeni e oggetti che si riferiscono all’uno e all’altro, restando
fermo il principio che si tratta di 2 stadi continui nel processo di
trasformazione e cambiamento del microcosmo e macrocosmo.
Ma Yin e Yang, essendo stadi opposti di un ciclo e stati diversi di
trasformazione, rappresentano la contrapposizione che costituisce
la forza generatrice di tutti i cambiamenti sensibili e insensibili,
sia nello sviluppo che nel decadimento dei fenomeni.
Nel concetto di medicina, secondo la filosofia cinese, lo Yin e lo
Yang costituiscono la base per interpretare qualsiasi fenomeno
fisiopatologico, clinico-diagnostico e infine terapeutico. E quindi
ogni tipo di trattamento può essere stabilito sulla base dei
seguenti 4 concetti fondamentali:
1. tonificare lo Yang;
2. tonificare lo Yin;
3. eliminare l’eccesso di Yang;
4. eliminare l’eccesso di Yin.
Inoltre, ogni parte del corpo umano è riferibile a questi 2 concetti
ed è in interrelazione con essi. Per esempio, l’area del torace è
Yang in relazione all’addome, ma è Yin in relazione alla testa.
Come regola generale, fanno parte dello Yang retro, testa, pelle,
muscoli, energia difensiva, ecc; fanno parte dello Yin fronte,
corpo, organi, energia nutritiva, ecc.
Quando rivolgersi all’auricoloterapia
Dolori osteoarticolari:
dolori reumatici o nevralgici, traumatici o degenerativi, acuti
o cronici;
artrosi a differenti livelli (cervicale, dorsale, lombare, anca,
arti inferiori e superiori);
alcuni tipi di tendinite (spalla, gomito, tendine d’Achille) e
dolori legamentari (caviglia, ginocchio);
sciatica, nevralgia cervicobrachiale, cefalea non emicranica,
certe forme di herpes zoster.
Disturbi connessi allo stress:
gastroduodenite;
ipertensione lieve;
astinenza da tabacco;
disturbi psicosomatici;
ansia;
stanchezza cronica;
lievi stati depressivi;
disturbi del sonno;
disturbi connessi con le allergie;
malattie dermatologiche su base psicosomatica;
ecc…
Disturbi in età pediatrica:
lievi stati ansiosi;
coliche addominali;
disturbi del sonno;
tic nervosi;
stanchezza di origine psicosomatica;
ecc.
Le origini dell’agopuntura auricolare
Le sue radici storiche risalgono all’antichità classica dei popoli
mediterranei - spiega il dottor Luigi Gori - anche se testimonianze
del suo uso sono presenti nel già citato Classico dell’Imperatore
Giallo del 200 a.C.
L’egittologo A. Varille ha documentato che le donne nell’antico
Egitto, quando desideravano non avere più figli, si facevano
cauterizzare un punto preciso dell’orecchio. Una pratica diffusa,
invece, tra gli antichi marinai, che solcavano le acque del
Mediterraneo, era quella di portare un orecchino infisso in un
punto dell’orecchio per migliorare la qualità della vista.
Ippocrate, il padre greco della medicina occidentale, descrisse la
scarificazione della regione posteriore dell’orecchio contro
l’impotenza sessuale e per trattare la sciatica. E ancora, Galeno
descrisse l’uso terapeutico della scarificazione dell’orecchio in
alcune patologie. Nei testi medici dell’antica Persia è descritta la
cauterizzazione dell’orecchio esterno sempre per il trattamento
della sciatica.
Anche nel Medioevo la pratica della cauterizzazione e della
scarificazione erano diffusi, come riportato dal medico portoghese
Zacatus Lusitanus nel 1637. In sostanza, nel corso dei secoli,
l’auricoloterapia costituì una pratica eminentemente empirica,
appannaggio di cerusici e barbieri, che praticavano la
cauterizzazione e la scarificazione delle orecchie nella terapia
della sciatica, delle malattie osteoarticolari in genere, nei disturbi
connessi con la sfera sessuale e la vista.
Nel 1957, il dottor Paul Nogier, un medico di Lione in Francia,
dopo un viaggio in Vietnam, per primo, presentò le sue
osservazioni sulla corrispondenza somatotopica della cute
dell’orecchio, ossia sulla corrispondenza tra alcune micro-aree
della cute dell’orecchio e macroaree anatomiche del corpo
umano. Nogier, che è considerato il padre dell’auricoloterapia,
sviluppò compiutamente il concetto che l’orecchio rappresentava
una specie di mappa in cui era rappresentato il corpo umano
secondo una disposizione che ricordava quella di un feto
capovolto a testa in giù. La ricerca di Nogier fu pubblicata per la
prima volta da una società tedesca di agopuntura e da lì
successivamente si diffuse in tutto il mondo occidentale, fino ad
approdare in Giappone e in Cina. In Cina fu preso molto sul serio
e venne iniziato da un’unità di medicina tradizionale dell’esercito
di stanza a Nanchino, sede della più antica università cinese di
medicina tradizionale, uno studio intensivo e di massa su 2000
pazienti, per creare una carta accurata dei punti auricolari. Finché
nel 1990, un simposio internazionale tenuto a Lione, sotto l’egida
dell’Organizzazione Mondiale della Sanità, stabilì una
standardizzazione dell’anatomia auricolare e rappresentò la
definitiva integrazione di questa disciplina nel sistema terapeutico
occidentale.
Capitolo III
Le evidenze scientifiche di trials clinici confermano o escludono la
sua efficacia? è efficace nei più comuni sintomi dispepsia,stipsi
,diarrea,colon irritabile ?
Da uno studio messicano :
[Prevalence of use of alternative and complementary medicine in patients with
irritable bowel syndrome, functional dyspepsia and gastroesophageal reflux
disease]
si evidenzia che la percentuale di soggetti che hanno patologie
gastroenteriche in un anno quelli che ricorrevano alla medicina CAM era il
61% per IBS o sindrome del colon irritabile,il 22 % per dispepsia ed il 17 %
per GERD o malattia da reflusso gastroesofageo.
Carmona-Sánchez R, Tostado-Fernández FA.
Servicio de Gastroenterología y Departamento de Medicina Interna, Centro Médico del Potosí-Hospital Angeles, San Luis
Potosí, SLP. [email protected]
Abstract
INTRODUCTION: The prevalence of use of complementary and alternative medicine (CAM) is high in developed
countries and is believed to be even higher in developing countries. There are no data on the use of CAM in patients with
gastrointestinal tract disorders in Mexico. OBJECTIVE: To determine the prevalence of CAM use in Mexican patients
with gastrointestinal disorders. Material and methods: A survey was applied to all first-time patients presenting at the
gastroenterology service between December 2003 and November 2004. Patients with irritable bowel syndrome (IBS,
defined by Rome II), functional dyspepsia (FD, defined by Rome II), and gastroesophageal reflux disease (GERD,
defined as erosive esophagitis or abnormal pH intraesophageal monitoring) were included. The use of CAM to relieve
gastrointestinal symptoms was examined and the demographic data, the disease history and healthcare use 12 months
prior to the study were recorded. RESULTS: The survey was answered by 413 patients (61% IBS, 22% FD y 17%
GERD). A total of 181 users of CAM were identified (44% of the total group). The use of CAM was most frequent for IBS
(51% IBS, 36% FD, 27% GERD). Herbal medicine was the type of CAM most often used by all groups. The factors
associated with CAM use were IBS, history of abdominal surgery, emergency room visits, disabilities and prescription of
benzodiazepines, and > or = 3 medical visits for gastrointestinal tract disorders within the previous year.
CONCLUSIONS: Prevalence of CAM use is high in general and significantly higher for IBS. Herbal medicine is the most
frequently used modality.
PMID: 17058977 [PubMed - indexed for MEDLINE]
Dal lavoro”
“EVALUATION OF RANDOMIZED CONTROLLED TRIALS ON
COMPLEMENTARY AND ALTERNATIVE MEDICINE”
Bernard S. Bloom a1, Aurélia Retbi a2, Sandrine Dahan a3 and Egon Jonsson
a1
University of Pennsylvania
a2
Université de Paris
a3
Université Renée Descartes
a4
Karolinska Institute and The Swedish Council on Technology Assessment in Health
Care (SBU)
a4
Sono stati trovati da MEDLINE e database correlati a CAM RCTs
circa 5000 trials ma di questi solo 258 rispettavo i criteri di
inclusione costituiti da RCT in cieco,diagnosi e terapia ben
specificate,studi completi esaminati da revisori critici delle
riviste ,pubblicati in lingua inglese e ciascuno studio indagato
da due revisori esterni ed indipendenti .Dei 5000 trials il 90 %
fu escluso perché non RCT e non in cieco d il punteggio per
circa 95 diagnosi/terapie era solo di 44.7 in una scala di 100.
Le conclusioni degli autori sono che vi è bassa evidenza negli
studi RCTs di medicina complementare alternativa ma essa
migliore lentamente nel tempo come per la medicina
occidentale.
Abstract
Objectives: Use of complementary and alternative medicine (CAM) is growing in all Western
countries. The goal of this study was to evaluate quality of randomized controlled trials (RCTs)
of CAM interventions for specific diagnoses to inform clinical decision making.
Methods: MEDLINE and related databases were searched for CAM RCTs. Visual review was
done of bibliographies, meta-analyses, and CAM journals. Inclusion criteria for review and
scoring were blinded RCT, specified diagnosis and intervention, complete study published
between January 1, 1966 and July 31, 1998 in an English-language, peer-reviewed journal.
Two reviewers independently scored each study.
Results: More than 5,000 trials were found, but only 258 met all study inclusion criteria. The
main cause for rejection (> 90%) was that the study was not an RCT or had no blinding. Mean
score across 95 diagnosis/intervention categories was 44.7 (S.D. ± 14.3) on a 100-point scale.
Ordinary least-squares regression found date of publication, biostatistician as author or
consultant, published in one of five widely read English-language medical journals and
diagnosis/intervention category of hypertension/relaxation as significant predictors of higher
scores.
Conclusions: The overall quality of evidence for CAM RCTs is poor but improving slowly over
time, about the same as that of biomedicine. Thus, most services are provided without good
evidence of benefit.
Key Words: Complementary medicine; Alternative medicine; Randomized controlled trials;
Quality evaluation.
back to top
Capitolo IV°
La conca superiore ed inferiore rappresenta la sede
dell’apparato digerente ma esso si proietta anche a cavallo della
radice del’elice.
C’è una buona sovrapposizione tra la scuola cinese e francese per
quanto riguarda la proiezione di bocca, esofago,cardias
,duodeno,intestino tenue,fegato,pancreas,colecisti e appendice.
Non c’è invece accordo per stomaco e milza.
Bourdiol (1980)studiò ed identificò l’area digestiva ; dimostrò che
l’area gastrica durante la digestione occupava la quasi totalità
della radice dell’elice ,dopo 3 ore l’area si era ridotta a spese di
quella del fegato e dopo 5 ore si era ulteriormente ridotta ed era
più evidente l’area intestinale.
Queste osservazioni portarono a rappresentare l’apparato
digerente sui due padiglioni tenendo conto della fisiologia oltre
che dell’anatomia,potendo così distinguere una fase gastrica,una
fase bilio-digestiva pancreatica ed una fase intestinale
intimamente correlate da neuro ormoni digestivi e da fenomeni
di motilità della muscolatura viscerale.
Nell’articolo”An approach to mechanism of function of auricular point”” Liu W, Xu G.
Institute of Acupuncture and Meridian, Anhui College of T C
M, Hefei.
Furono studiati gli effetti elettrofisiologici e gastrointestinali su
ratti con nervo vago intatto,grande auricolare ,catena cervicale
simpatica e de nervazione auricolare .Gli studi elettrofisiologici e
la motilità indagati a livello dell’esofago,antro,duodeno e
intestino erano presenti e duravano nel temo solo ad
innervazione completa del padiglione auricolare mentre a de
nervazione completa gli effetti erano nulli.’
Le stessa osservazioni furono fatte da Bourdiol prima e dopo la defecazione e la
minzione per le aree del colon e della vescica,dimostrando un parallelismo tra la
proiezione del viscere e la sua funzione.
Questi fenomeni sono osservabili a carico della conca innervata dal vago e non sono
osservabili sulla parte interna dell’antelice , proiezione della catena simpatica laterovertebrale.
Secondo Bourdiol la camera gastrica avvolge la radice dell’elice per cui è molto
vicino al punto Zero mentre la grande curvatura a sx arriva fino ai 2/3 della distanza
dall’antelice sx.
Secondo Bourdiol la grande curvatura si proietta sul padiglione sx,l’antro sul
padiglione dx;il piloro ed il bulbo duodenale si proiettano a dx mentre la porzione
distale del duodeno e l’intestino tenue sono proiettati a sx.
Romoli(1987)fotografando le alterazioni cutanee della conca superiore ed inferiore ed
in cieco con l’indagine endoscopica (175 pazienti)la diagnosi risultò positiva
nell’82,3% ad entrambe le diagnostiche endoscopica ed auricolare;nel 17,7% risultò
negativa.
Dallo studio,riportato nel testo di agopuntura auricolare–Utet , Romoli deduce che la
maggiore o minore distanza delle alterazioni cutanee e dei punti sensibili dal punto
Zero permette di discriminare a grandi linee una patologia digestiva funzionale da
una organica.
Una lesione documentabile alla gastroscopia(ulcera,gastroduodenite) tende perciò a
proiettarsi nelle vicinanze della radice dell’elice mentre una disfunzione (dispepsia o
somatizzazione) tende piuttosto a proiettarsi in periferia.
Fa eccezione l’esofago con il dolore retro sternale costrittivo tipico dell’esofagite,da
una proiezione sul padiglione che tende ad estendersi verso l’area del cuore o il punto
dell’ansia di Jarricot posto sul settore ( a 2/3 di distanza dal punto Zero .Talvolta il
dolore del duodeno e dell’intestino tenue si proiettano sul padiglione sx.
Molti studi sono in corso per il controllo della nausea/vomito da chemioterapia,ad
esempio (2008):
―Stimulation of auricular Acupuncture –points for chemiotheraspy-induced nausea
vomiting‖ ;National Taiwan university Hospital;numero dei soggetti arruolati 120.
Per quanto riguarda il reflusso biliare con o senza colecistectomia i punti evocabili
si localizzano in periferia andando a coprire le zone di proiezione del fegato,delle vie
biliari,ed in parte dell’esofago.
Il reflusso indagato con la gastroscopia,con la scintigrafia al tallio,con l’ecografia non
hanno concluso se il reflusso biliare è patologia a se stante in persone emotive ed
iperattive con abuso di dolci,caffè,alcool e fumo o se collegato a patologie diverse tra
cui la calcolosi colecistica.
Nei portatori di calcolosi biliare ,soprattutto se di sesso femminile,si può osservare
una telangectasia della conca superiore.
La proiezione della colecisti è diversa nelle due scuole;per i francesi è situata a metà
strada tra il punto Zero e l’antelice sui settori 13-14,mentre per i cinesi è situata in
periferia sui settori 16-18 del settogramma di Romoli.
Per i francesi la proiezione del fegato è unica ,mentre sulle mappe cinesi ,secondo la
MTC,si trovano più punti ed aree correlate con l’organo e le sue funzioni .
Secondo i cinesi dall’alto in basso si trovano nell’area epatica il punto
fegato con indicazioni relative ai disturbi dell’orecchio,del sistema
emopoietico,del sistema nervoso e dell’apparato muscolare,e due aree
dell’epatomegalia della sezione sx e dx rispettivamente sui padiglioni
corrispondenti;tra le due c’è la “linea della schistosomiasi “per la
splenomegalia e la cirrosi,e un punto rilassamento muscolare (ipoalgesia
per la muscolatura addominale in corso di intervento chirurgico)e sul
davanti il punto epatite.
Effect of electroacupuncture on visceral hyperalgesia, serotonin and fos expression
in an animal model of irritable bowel syndrome.
Wu JC, Ziea ET, Lao L, Lam EF, Chan CS, Liang AY, Chu SL, Yew
DT, Berman BM, Sung JJ.
Institute of Digestive Disease, The Chinese University of Hong Kong.
Per lesioni irreversibili del fegato,come nelle cirrosi epatica da abuso di
alcool,nel 50% dei casi si possono evidenziare zone di disepitelizzazione
,desquamazione ed ipertrofia della ‘area epatica.
La milza per i cinesi ha dimensioni ragguardevoli e per la MTC le sue
indicazioni terapeutiche riguardano ,oltre a disturbi intestinali come diarrea
,stipsi e meteorismo,anche disturbi della sfera ginecologica.
Nella pancreatite cronica i punti si proiettano sulla parte alta della conca
superiore ,dove sia i francesi che i cinesi localizzano l’area pancreatica.
Per Nogier l’intestino tenue scende verso la radice dell’elice per
congiungersi con il duodeno e spesso è difficile distinguere l’area del
duodeno dall’intestino tenue come in corso di dispepsia non ulcerosa o
gastroduodenite.
La proiezione del colon ,nascosto in avanti dietro la radice dell’elice,è spesso
positiva alla detezione elettrica e se c’è discheratosi localizzata alla conca
superiore si può trattare di una colite cronica,di una diverticolosi o, meno
spesso, di una retto-colite ulcerosa in fase latente.
L’agopuntura sull’area del colon a sx ha un discreto successo sulla stipsi.
“Nursing care of cerebral apoplexy patients accepting ear
acupoint bean pressing to prevent complicating with
constipation in acute phase”.Wang Junling(TCM Hospital of Huairou
Region of Beijing City,Beijing 101401 China) Statiscamente significativo la
terapia auricolare con semi di vaccaria nel prevenire la stipsi.’
The Journal of Alternative and Complementary Medicine
A Review on the Complementary Effects of Auriculotherapy in Managing
Constipation.
The Journal of Alternative and Complementary
Medicine
Tra l’intestino tenue ed il colon troviamo il punto dell’appendice ,utile per una
diagnosi differenziale.
Entrando nella conca inferiore ,subito sotto la radice dell’elice ,troviamo alcuni
punti relativi all’apparato digerente superiore e sono la proiezione del
cardias,dell’esofago e della bocca.
In caso di reflusso gastroesofageo si può osservare una tipica iperemia sotto
la radice dell’elice ;in corrispondenza dell’incisura elicotragica si trova la
bocca.
Per i cinesi l’area prevede oltre alle affezioni del cavo orale (ulcere , afte ) e
della lingua anche anomalie del comportamento alimentare ,il globo
isterico,ed il vomito nervoso.
Punti sensibili in questa zona si trovano in persone affette da agorafobia con
o senza attacchi di panico o altre fobie semplici come per gli ascensori,il buio
o lo stare da soli tanto da far pensare che la proiezione esofago-bocca sia
una vera e propria area della paura.
Si riportano ad illustrazione di quanto affermato la
presentazione generale ed in particolare di un lavoro che
rispetti i criteri della EBM.
This investigation was performed with thirty adult rabbits which divided auricular vagus, great auricular, cervical
sympathetic and all auricular denervation. By gastrointestinal electro-physiologic methods, the changes of
gastrointestinal electric activity in corpus, antrum, duodenum and colon were observed with car needing to evaluate the
mechanism of function of auricular point
Publication Types, MeSH291 cases of cholelithiasis treated with electric
shock on otoacupoints.
Zhang Y, Zhang L, Yang H, Zhang H, Zhu Y.
Da Tong Railway Hospital.
Abstract
Since 1985, the authors began to use electric shock on otoacupoints of varying electric resistance for the treatment of
cholelithiasis. The instrument used was the Channel Therapeutic Instrument made in China, and the otoacupoints of
varying electric resistance were Sympathetic, Pancreas--Gall Bladder, Stomach, Liver, Sanjiao, Endocrine, and Ermigen.
In the 1291 cases treated, the total effective rate was 99.69%, the rate of calculus excretion was 91.32%, and the rate of
total excretion was 19.51%. The composition of the calculi was cholesterol crystals (31.25%), bilirubin crystals (28.17%),
and mixed crystals (40.58%). The largest calculus excreted was an extrahepatic biliary duct calculus of 1.75 cm X 1.5
cm; the largest number of calculi excreted was 152 cholecystic stones 0.3 cm X 0.5 cm in size. In 100 random cases, the
biliary system was shown to manifest vigorous dilations and constrictions under Ultrasonic B-scan when the relevant
otoacupoints were stimulated with electric shock. Among the 78 control cases, no cholecystic stones were excreted,
inspite of the Magnesium Sulfate, Folium Cassiae and fatty meals administered to many cases with constipation.
PMID: 1861515 [PubMed - inde
Ter[An approach to mechanism of function of auricular point]
[Article in Chinese]
Liu W, Xu G.
Institute of Acupuncture and Meridian, Anhui College of T C M, Hefei.
Abstract
mechanism of function of auricular point. Results: In intact car innervation, the changes of gastrointestinal electric activity
on ear needling were obvious (P less than 0.05-0.01). While the one with ear nerve selected showed that influence of ear
acupuncture still remained, but when the whole auricle was denervated the influence of ear needling on gastrointestinal
electric activity obviously deceased or disappeared. pro- and post needing the changes on gastrointestinal electric
activity were not statistically different (P greater than 0.05). Recordings at the four parts of digestive tract gave similar
results in frequency, amplitude, motility index, action area integral. Exerting stimulation on gastric vagus or sympathetic
nerves could bring about double phase modulatory (excitatory or inhibitory). The above revealed that the functions of ear
point in diagnosis and therapy is not due to one kind of nerves in periphery. The functions of ear point at innervation may
be in its entirety. It was reported that function of ear points has something to do with auricular vagus or great auricular or
sympathetic nerves, but, this is only one side of the matter. Moreover, since auricular point are associated with various
propagation tracts and with modulation of nerve centers, their mechanism is very complicated and needs to be further
studies.
PMID: 2125876 [PubMed - indexed for MEDL
Page updated June, 2007
Found 25 studies with search of: auricular therapy
Hide studies that are not seeking new volunteers.
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Rank
Status
Study
1
Active, not
recruiting
Climacteric Clinical Trial : the Use of Complementary Therapy and Hormonal
Replacement
Condition: Climacteric
Interventions: Other: flower therapy;
Other: therapeutic touch;
Other: auricular therapy; Drug: Hormones
2
Completed
Auricular Acupuncture for Acute Pain
Condition: Acute Pain
Intervention: Procedure: Acupuncture
3
Completed
Auricular Acupuncture in Postoperative Pain
Condition: Acupuncture
Interventions: Device: electrical auricular acupuncture;
Device: P-Stim™ devices were applied
without lectrical stimulation and
cupuncture.
4
Recruiting
Auricular Acupressure for Perimenopausal Women With Anxiety
Conditions: Auricular Acupressure; Anxiety;
Menopause; Insomnia
Interventions: Other: auricular acupressure;
Other: sham acupressure
5
Completed
Myopia Control by Combining Auricular Acupoint and Atropine Eyedrops
Condition: Myopia
Interventions: Drug: 0.25 % atropine; Drug: 0.5 % atropine;
Procedure: 0.25 % atropine+auricular acupoints
6
Recruiting
Stimulation of Auricular Acupuncture-Point for Chemotherapy-Induced
Nausea/Vomiting
Condition: Cancer
Interventions: Procedure: Auricular acupuncture;
Procedure: Sham auricular acupuncture
7
Completed
Use Ear Acupuncture as Treatment for Low Back Pain During Pregnancy
Condition: Pregnancy Related Low Back Pain
Interventions: Other: acupuncture;
Other: Sham acupuncture;
Other: standard of care
8
Completed
Safety and Efficacy Study of Isolagen Therapy in the Treatment of Nasolabial
Fold Wrinkles
Condition: Bilateral Nasolabial Fold Wrinkles
Interventions: Biological: Autologous Human Fibroblasts
(Isolagen TherapyTM);
Biological: Placebo
9
Completed
Safety and Efficacy Study of Isolagen Therapy in the Treatment of Severe
Facial Acne Scarring
Condition: Acne Scarring of the Face
Interventions: Biological: Autologous Human Fibroblasts
Biological: Placebo
10 Completed
Safety and Efficacy Study of Isolagen TherapyTM in the Treatment of
Nasolabial Fold Wrinkles
Condition: Bilateral Nasolabial Fold Wrinkles
Interventions: Biological: Autologous Human Fibroblast
Biological: Placebo
11 Completed
Study of Low Level Laser Therapy and Word Recognition in Hearing Impaired
Individuals
Condition: Sensorineural Hearing Loss
Interventions: Device: The Hearing Laser;
Device: Placebo Laser
12 Recruiting
Preparation Rich in Growth Factors (PRGF) Treatment for Osteoarthritis of the
Knee
Condition: Osteoarthritis of the Knee
Interventions: Biological: PRGF; Drug: hyaluronic acid;
Drug: placebo
13
Traumeel for Post-Tonsillectomy Pain
Condition: Post-Tonsillectomy
Interventions: Drug: Traumeel S; Drug: TRAUMEEL S;
Drug: Placebo
Not yet
recruiting
14 Suspended
Topical Voltaren in Otitis Externa
Condition: Otitis Externa
Interventions: Drug: diclofenac sodium; Drug: dexotc
15 Completed
Impact of Acupuncture on Vasomotor Rhinitis
Conditions: Vasomotor Rhinitis; Acupuncture
Interventions: Device: Acupuncture; Device: Shamlaser acupuncture
16 Completed
Auricular Acupuncture for Pain Relief After Ambulatory Knee Arthroscopy
Condition: Postoperative Pain
Intervention: Procedure: Auricular acupuncture
17 Recruiting
Auricular Acupuncture for Analgesia During Total Hip Arthroplasty
Conditions: Acute Pain; Total Hip Arthroplasty
Intervention: Procedure: Auricular acupuncture (procedure)
18 Recruiting
Does Auricular Acupuncture Improve Tolerance to Electromyography (EMG)
Testing?
Condition: Pain
Intervention: Other: auricular acupuncture
19 Completed
Tissue Engineering Microtia Auricular Reconstruction: in Vitro and in Vivo
Studies
Condition: Microtia
Interventions: Other: Platelet-rich plasma (PRP);
Other: Chondrocyte culture with FBS medium
20 Recruiting
The Effect of Auricular Point Stimulation on Obese Women
Condition: Obesity
Interventions: Other: ear-acupuncture A;
Other: stimulation B; Other: stimulation C
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Lister Hill National Center for Biomedical Communications, U.S. National Library of Medicine,
U.S. National Institutes of Health, U.S. Department of Health & Human Services,
USA.gov, Copyright, Privacy, Accessibility, Freedom of Information Act
Stimulation of Auricular Acupuncture-Point for
Chemotherapy-Induced Nausea/Vomiting
This study is currently recruiting participants.
Verified by National Taiwan University Hospital, November 2008
First Received: August 4, 2006 Last Updated: November 7, 2008 History of Changes
Sponsor: National Taiwan University Hospital
Information provided by: National Taiwan University Hospital
ClinicalTrials.gov Identifier: NCT00360841
Purpose
The purpose of this study is to evaluate auricular acupuncture as an
antiemetic treatment compared with sham acupuncture and with no acupuncture in
patients receiving moderately-high to highly emetogenic chemotherapy. Acupuncture
constitutes a nonpharmacological intervention for chemotherapy-induced nausea/vomiting
(CINV). Chinese medicine holds that stimulating select points both on the body and the
ear, that lie along meridians or life channels, can relieve diseases.
Condition
Cancer
Intervention
Procedure: Auricular acupuncture
Phase
Phase III
Study Type:
Interventional
Study Design:
Allocation: Randomized
Control: Placebo Control
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Crossover Assignment
Masking: Double Blind (Subject, Caregiver, Investigator)
Primary Purpose: Treatment
Official Title:
Stimulation of Auricular Acupuncture-Point for Chemotherapy-Induced
Nausea/Vomiting: A Prospective Randomized Double-Blind Cross-Over Study
Resource links provided by NLM:
MedlinePlus related topics: Acupuncture Nausea and Vomiting
U.S. FDA Resources
Further study details as provided by National Taiwan University Hospital:
Primary Outcome Measures:
At baseline visit and course 1, 2, 3, and 4 after chemotherapy, every
subject will have been efficacy evaluated by FILE, vomiting visual
analog scale, WHOQOL-Brief questionnaire and Chinese Disposition
Classification. [ Time Frame: subject ]
Estimated Enrollment:
120
Study Start Date:
June 2006
Estimated Study Completion Date:
June 2008
Arms
Assigned Interventions
A: Experimental
The subjects in arms A and B will
receive auricular acupuncture.
The subjects in arms A will receive
auricular acupuncture (at 2nd and
4th chemotherapy courses) as
well as the sham auricular
Subjects will be randomized to one of these arms.
The subjects in arm A and B will
receive auricular acupuncture. Before subjects
receive chemotherapy within one day, they will be
treated by auricular acupuncture, sham acupuncture,
or control group.
acupuncture (at the 3rd
chemotherapy course).
B: Sham Comparator
The subjects in arms A and B will
receive auricular acupuncture.
The subjects in arm B will receive
the sham auricular acupuncture
(at the 2nd and 4th chemotherapy
courses) and auricular
acupuncture (at the 3rd
chemotherapy course).
Subjects will be randomized to one of these arms.
The subjects in arm A and B will
receive auricular acupuncture. Before subjects
receive chemotherapy within one day, they will be
treated by auricular acupuncture, sham acupuncture,
or control group.
C: No Intervention
No treatment received.
Show Detailed Description
Eligibility
Ages Eligible for Study:
Genders Eligible for Study:
Accepts Healthy Volunteers:
Criteria
18 Years and older
Both
No
Inclusion Criteria:
Histologically or cytologically confirmed carcinoma
Patients must have normal organ and marrow function as defined below:
o
o
ANC greater than or equal to 1500/mcL
Platelets greater than or equal to 100,000/mcL
AST (SGOT)/ALT (SGPT) less than 5 x institutional upper limit of
normal
o Creatinine within normal institutional limits, OR
o Creatinine clearance greater than or equal to 60 mL/min/1.73 m2
for patients with creatinine levels less than 1.5mg/dl
Patients should have the ability to understand and the willingness to sign
a written informed consent document
o
Exclusion Criteria:
Patients with known CAD, CVA, epilepsy, hypotension, hypertension
Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00360841
Contacts
Contact: Chih-Hsin Yang, PhD
886-2-23123456 ext 7511
[email protected]
Contact: Ching-Hung Lin, M.D.
886-2-23123456 ext 7573
[email protected]
Locations
Taiwan
Department of Oncology, National Taiwan University Hospital
Taipei, Taiwan, 100
Contact: Chih-Hsin Yang, PhD 886-2-23123456 ext 7511
[email protected]
Contact: Ching-Hung Lin, M.D. 886-2-23123456 ext 7573
[email protected]
Principal Investigator: Chih-Hsin Yang, PhD
Sponsors and Collaborators
National Taiwan University Hospital
Investigators
Principal
Investigator:
Chih-Hsin Yang,
PhD
Recruiting
Deparment of Oncology, National Taiwan
University Hospital
More Information
No publications provided
ClinicalTrials.gov Identifier:
NCT00360841
History of Changes
Other Study ID Numbers:
9561702041
Study First Received:
August 4, 2006
Last Updated:
November 7, 2008
Health Authority:
Taiwan: Department of Health
Keywords provided by National Taiwan University Hospital:
auricular
acupuncture
Additional relevant MeSH terms:
Signs and Symptoms
Vomiting
Signs and Symptoms, Digestive
Correlation auricular acupoint diagnosis with the affected
region of acute abdominalgia and Location diagnosis
AN APPROACH TO MECHANISM OF FUNCTION OF
AURICULAR POINT
Liu Weizhou; Xu Guansun; et al(Institute of Acupuncture and Meridian,Anhui Cottege of T C M, Hefei)
This invcsligation was pcrformcd with thirty adult rabbits which dividcd auricular vagus, great auricular, cervical sympathcric
and all auricular denervation.By gastrointestinal electro-physiologic methods, the changes of gastroiutestihal electric activity in
corpus, antrum, dudenum and colon were observed with ear needing to evaluate the mechanism of function of auricular point.
Results: In intact car innervation,the changes of gastrointestinal electricactivity on car needling were obvious (P0.05—0.01). While
the one with carnerve sected showed that influence of ear acupuncture still remaincd, but whenthe whole auricle was dencrvatcd the
influcnce of car needling on gastrointestinalelectric activity obvicusly deceased or disappeared, pre-and post needing thechanges on
gastrointestinal electric activity were not statistically different (P0.05). Recordings at the four parts of digestive tract gave similar
rcsults infrequancy, amplitude, inotility index, action area integral. Exerting stimulation on gastric vagus or sympathetic nerves could
bring about double phase modulatory (excitory or inhibitory). The above revealed that the functions of car point in diaghosis and
therapy is not due to one kind of nerves in periphery. The functions of ear point at innervation may be in its entirety. It was rcportcd
that function of car points has something to do with auricular vagus or great auricular or sympathetic nerves, but,this is only one side
of the matter. Moreover,since auricular point are associated with various propagatal tracts and with modulation of nerve centers, their
mechanism is very complicated and needs to be further studies.
【Key Words】：
LIU Ji-hong,HE Xiu-zhen,LIU Zhao-hong,et al.(Foshan Municipal Hospital of Traditional Chinese Medicine,F
Nursing care of cerebral apoplexy patients accepting ear
acupoint bean pressing to prevent complicating with
constipation in acute phase
Wang Junling(TCM Hospital of Huairou Region of Beijing City,Beijing 101401 China)
Objective:To probe into the prevention effect of ear acupoint bean pressing for cerebral apoplexy patients from complicating
with constipation in acute phase.Methods:A total of 120 cerebral apoplexy patients in acute phase were randomly divided into test
and control group.Routine treatment and nursing care were carried out for control group patients.Besides the routine
treatment,patients of test group were given ear acupoint bean pressing,3～5 times daily,and 3～5 minutes per time until patients felt
sore and callous,distending,pain and scorching in ears.Both ears were pressed in turn for three days,and totally lasting for 12
days.Then defaecation of patients were recorded every day.Patients were with constipation or not judged according to the Rome III
standard.The incidences of constipation of the two group patients were compared.Results:There was statistical significant difference
in occurrence of constipation between the two groups(P0.01).Conclusion:Ear acupoint bean pressing can prevent constipation for
cerebral apoplexy patients effectively.
【Key Words】： cerebral apoplexy ear acupoint bean pressing prevention constipation
Constipation
To cite this article:
Mei-Kuen Li, Tze-Fan D. Lee, Kwai-Ping L. Suen. The Journal of Alternative and Complementary Medicine.
April 2010, 16(4): 435-447. doi:10.1089/acm.2009.0348.
Published in Volume: 16 Issue 4: April 27, 2010
Full Text: • HTML • PDF for printing (114 KB) • PDF w/ links (127.3 KB)
Mei-Kuen Li, R.N., M.A.,1
2
Tze-Fan D. Lee, R.N., Ph.D., and
Kwai-Ping L. Suen, R.N., Ph.D.2
1
School of Science and Technology, The Open University of Hong Kong, Hong Kong, China.
2
The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China.
Address correspondence to:
Mei-Kuen Li, R.N., M.A.
School of Science and Technology
The Open University of Hong Kong
Room A0922
30, Good Shepherd Street
Ho Man Tin, Kowloon
Hong Kong 852
China
E-mail:
Abstract
Background: Constipation is a common health problem that adversely affects an individual's general health
and quality of life. Constipated people usually manage the problem by taking laxatives and by modifying their
lifestyle even if such have questionable therapeutic effects. Auriculotherapy, a safe treatment modality in
Chinese medicine, has been reported to be effective in managing constipation. Despite previous studies
reported encouraging results in using auriculotherapy, its effectiveness in managing constipation has not
been systematically reviewed. This review, therefore, examines previous studies that have investigated the
effectiveness of auriculotherapy in managing constipation.
Method: A search in the databases of MEDLINE,® EMBASE, AMED, and China Academic Journals Full-text
Database and manual searching were performed to identify relevant clinical studies.
Results: A total of 29 relevant clinical studies conducted from 1994 to 2008 were identified. All of the studies
reported that auriculotherapy was effective in managing constipation. However, generalization of their
findings was limited because of two significant methodological flaws: (1) uncertainty in accurate acupoints
identification and subjects' compliance to instructions resulted in varied doses of intervention received; and
(2) inconsistent intervention protocols and therapeutic outcome criteria made comparison among different
studies difficult.
Conclusions: The findings of this review could provide pertinent information for researchers in terms of
study designs and methodologies that may be used for future studies. The use of randomized controlled
trials on a sample of sufficient size and of standard intervention protocol is recommended to provide
empirical evidence that will support auriculotherapy as a complementary strategy in managing constipation.
Users who read this article also read
Therapeutic Effect of Acupuncture Combined with Herbal
Application on Ear Acupoint for Vomiting Induced by
Chemotherapy:A Report of 60 Cases
TAI Jie LIU Feng SUN Lijing
Objective:To observe the preventive and therapeutic effect of acupuncture combined with herbal application on ear acupoint
for vomiting induced by chemotherapy.Methods:One hundred and twenty patients were equally randomized into 2 groups:the
treatment group received acupuncture combined with herbal application on ear acupoint,and the control group received
ondansetron.The effect on relieving nausea and vomiting was observed,and the incidence of side effects was evaluated. Results:The
total effective rate for relieving nausea and vomiting in the treatment group was higher than that in the control group(P0.05).After
treatment, side effects of headache,dizziness and constipation occurred in 16 patients of the control group,while no side effect was
found in the treatment group.The difference of incidence of side effects was significant between the two groups(P0.05).Conclusion:
Acupuncture combined with herbal application on ear acupoint has a better effect on regulating gastrointestinal function,and has
preventive and therapeutic effect for vomiting and nausea induced by chemotherapy.
【Key Words】：
1291 cases of cholelithiasis treated with electric shock on otoacupoints.
Abstract
Zhongguo Zhong Yao Za Zhi. 2008 Oct;33(20):2404-6.
[Clinical curative effect of combination between medicine and acupoint flow on
SOD, NO in patients with ulcerative colitis]
Du YR, Li DG, Zhang W, Zhu F, Liu QG.
Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang 050011, China.
Abstract
OBJECTIVE: To investigate the clinical curative effect of the combination between medicine and acupoint flow on SOD,
NO in patients with ulcerative colitis.
METHOD: Two hundred sixty two patients with ulcerative colitis were randomly divided into four groups: the patients in
traditional Chinese medicine group were fed with changpikang, the patients in ear acupoint group were pasted and
pressed spleen, large intestine, sympathesis, subcortex; the patients in medicine and acupoint group were taken with
Changpikang and ear acupoint; the patients in treatment group were treated by taking sulfasalazine, with a treatment
course of four weeks. The changes of SOD, NO before and after treatments were recored.
RESULT: There was a significant difference between four groups before and after treatment (P < 0.05), medicine and
acupoint group was superior to that others (P < 0.05).
CONCLUSION: The method of combination between medicine and acupoint could increase the contents of SOD,
decrease the level of NO, elevate the potential of organism to resist oxygen free radical and promote intestinal tract ulcer
concrescence.
Publication Types, MeSH Terms, Substances
Does auricular acupuncture reduce postoperative vomiting after cholecystectomy?
Sahmeddini MA, Fazelzadeh A.
Department of Anaesthesiology, Shiraz University of Medical Sciences, Faghihi Hospital, Shiraz, Iran.
[email protected]
Abstract
PURPOSE: To find the efficacy of auricular acupuncture for the prevention of postoperative nausea and vomiting after
cholecystectomy.
MATERIALS AND METHODS: One hundred (100) female patients undergoing transabdominal cholecystectomy were
randomly allocated to two groups of 50 (auricular acupuncture treatment group and nontreatment group) in order to test
the effectiveness of auricular acupuncture. Statistical significance (p < 0.05) was determined using an unpaired t-test for
age, weight, height, and duration of anesthesia; a chi-square test was used to analyze the incidence of vomiting.
RESULTS: There was no significant difference in age, weight, height, or duration of anesthesia among the two groups of
patients. There was a significant difference between the control and auricular acupuncture treatment groups in the
incidence of vomiting 24 hours after surgery (66% and 0%, respectively, p < 0.01). No noteworthy side effects from
treatment were observed.
CONCLUSION: Auricular acupuncture is effective in reducing vomiting following transabdominal chol
Evid Based Complement Alternat Med. 2009 Mar;6(1):31-9. Epub 2007 Nov 21.
Prospective tests on biological models of acupuncture.
Shang C.
Department of Medicine, Cambridge Health Alliance, Harvard Medical School, 103 Garland Street, Everett, MA 02149, USA. [email protected].
Abstract
The biological effects of acupuncture include the regulation of a variety of neurohumoral factors and growth control
factors. In science, models or hypotheses with confirmed predictions are considered more convincing than models solely
based on retrospective explanations. Literature review showed that two biological models of acupuncture have been
prospectively tested with independently confirmed predictions: The neurophysiology model on the long-term effects of
acupuncture emphasizes the trophic and anti-inflammatory effects of acupuncture. Its prediction on the peripheral effect
of endorphin in acupuncture has been confirmed. The growth control model encompasses the neurophysiology model
and suggests that a macroscopic growth control system originates from a network of organizers in embryogenesis. The
activity of the growth control system is important in the formation, maintenance and regulation of all the physiological
systems. Several phenomena of acupuncture such as the distribution of auricular acupuncture points, the long-term
effects of acupuncture and the effect of multimodal non-specific stimulation at acupuncture points are consistent with the
growth control model. The following predictions of the growth control model have been independently confirmed by
research results in both acupuncture and conventional biomedical sciences: (i) Acupuncture has extensive growth control
effects. (ii) Singular point and separatrix exist in morphogenesis. (iii) Organizers have high electric conductance, high
current density and high density of gap junctions. (iv) A high density of gap junctions is distributed as separatrices or
boundaries at body surface after early embryogenesis. (v) Many acupuncture points are located at transition points or
boundaries between different body domains or muscles, coinciding with the connective tissue planes. (vi) Some
morphogens and organizers continue to function after embryogenesis. Current acupuncture research suggests a
convergence of the neurophysiology model, the connective tissue model and the growth control model. The growth
control model of acupuncture set the first example of a biological model in integrative medicine with significant prediction
power.
PMID: 18955283 [PubMed - in process]PMCID: PMC2644274Free PMC ArticZhongguo Zhen Jiu. 2007 May;27(5):345-8.
[Clinical study on correlativity of stagnation of the liver-qi with tenderness response
of auricular points]
Liu J, Liang-duo J, Zhao JP.
Department of Internal Medicine, Dongzhimen Hospital, Beijing University of TCM, Beijing 100700, China.
[email protected]
Abstract
OBJECTIVE: To probe into the correlativity of TCM syndromes to auricular points.
METHODS: Sixty-three cases of typical liver-qi stagnation syndrome and 52 healthy persons were divided into an
observation group and a control group, respectively. The auricular points on both side were respectively detected by
auricular point pressure pain method with spring pressure bar and a pressure of 50 g, and then the number of auricular
points with positive response on both sides were respectively calculated and the positive rates between the two groups
were compared.
RESULTS: Can (liver), Shidao (esophagus), Sanjiao (triple energy), Pi (spleen), Yidan (pancreas and gall bladder),
Tingzhong (center of superior concha), Wei (stomach), Shenmen had high tenderness positive rates, with significant
differences between the liver-qi stagnation syndrome group and the healthy person group. The correlativity were
Gan>Shidao>Sanjiao>Pi>Yidan>Tingzhong>Wei>Shenmen.
CONCLUSION: TCM syndromes and auricular points have correlativity.
[Study on effects of low frequency pulse plus auricular point magnetic therapy on
electrogastrogram and clinical therapeutic effect in the patient of functional
dyspepsia]
Wang YG, Yao SK.
Department of Digestion, The Affiliated Hospital of TCM, Hebei Medical University, Shijiazhuang 050011, China.
[email protected]
Abstract
OBJECTIVE: To compare therapeutic effects of low frequency pulse plus auricular point magnetic therapy and prepulsid
on functional dyspepsia (FD).
METHODS: Fifty cases of FD were randomly divided into a treatment group and a control group. The treatment group
were treated with low frequency pulse stimulation on Zhongwan (CV 12), Weishu (BL 21), Neiguan (PC 6), Zusanli (ST
36), with Fenglong (ST 40) and Sanyinjiao (SP 6) selected according to syndrome differentiation, once a day, 30 min
each session. The control group were treated with oral administration of prepulsid. Five days constituted one course. The
scores of symptoms and parameters of electrogastrogram (EGG) before and after treatment and the therapeutic effect
were investigated.
RESULTS: After treatment, the symptom scores significantly decreased (P < 0.01), with a significant difference in the
decrease of symptom scores between the two groups (P < 0.05); and EGG parameters were improved (P < 0.05). The
total effective rate of 93.3% in the treatment group was better than 75.0% in the control group with a significant difference
between the two groups (P < 0.05).
CONCLUSION: Low frequency pulse plus auricular point magnetic therapy can significantly improve the clinical
symptoms and gastric activities in the patient of FD, with a better therapeutic effect than prepulsid.
Publication Types, MeSH Terms
Acupuncture for treatment of irritable bowel syndrome.
Lim B, Manheimer E, Lao L, Ziea E, Wisniewski J, Liu J, Berman B.
University of Maryland School of Medicine, Center for Integrative Medicine, Kernan Hospital Mansion, 2200 Kernan Drive,
Baltimore, Maryland 21207-6697, USA.
Abstract
BACKGROUND: Irritable bowel syndrome (IBS), a disorder of altered bowel habits associated with abdominal pain or
discomfort. The pain, discomfort, and impairment from IBS often lead to healthcare medical consultation (Talley 1997)
and workplace absenteeism, and associated economic costs (Leong 2003). A recent randomized controlled trial shows
variable results but no clear evidence in support of acupuncture as an effective treatment for IBS (Fireman 2001).
OBJECTIVES: The objective of this systematic review is to determine whether acupuncture is more effective than no
treatment, more effective than 'sham' (placebo) acupuncture, and as effective as other interventions used to treat irritable
bowel syndrome. Adverse events associated with acupuncture were also assessed.
SEARCH STRATEGY: The following electronic bibliographic databases were searched irrespective of language,
date of publication, and publication status: MEDLINE, the Cochrane Central Register of Controlled Trials
(CENTRAL) on The Cochrane Library, EMBASE, the Chinese Biomedical Database, the Cumulative Index to
Nursing and Allied Health (CINAHL), and the Allied and Complementary Medicine Database (AMED). References
in relevant reviews and RCTs were screened by hand. The last date for searching for studies was 7 February
2006.
SELECTION CRITERIA: Published reports of randomized controlled trials (RCTs) and quasi-randomised trials of
acupuncture therapy for IBS.
DATA COLLECTION AND ANALYSIS: All eligible records identified were dually evaluated for eligibility and
dually abstracted. Methodological quality was assessed using the Jadad scale and the Linde Internal Validity
Scale. Data from individual trials were combined for meta-analysis when the interventions were sufficiently
similar. Heterogeneity was assessed using the I squared statistic.
MAIN RESULTS: Six trials were included. The proportion of responders, as assessed by either the global symptom
score or the patient-determined treatment success rate, did not show a significant difference between the acupuncture
and the sham acupuncture group with a pooled relative risk of 1.28 (95% CI 0.83 to 1.98; n=109). Acupuncture treatment
was also not significantly more effective than sham acupuncture for overall general well-being, individual symptoms (e.g.,
abdominal pain, defecation difficulties, diarrhea, and bloating), the number of improved patients assessed by blinded
clinician, or the EuroQol score. For two of the studies without a sham control, acupuncture was more effective than
control treatment for the improvement of symptoms: acupuncture versus herbal medication with a RR of 1.14(95% CI
1.00 to 1.31; n=132); acupuncture plus psychotherapy versus psychotherapy alone with a RR of 1.20 (95% CI 1.03 to
1.39; n=100). When the effect of ear acupuncture treatment was compared to an unclearly specified combination of one
or more of the drugs diazepam, perphenazine or domperidone, the difference was not statistically significant with a RR of
1.49(95% CI 0.94 to 2.34; n=48).
AUTHORS' CONCLUSIONS: Most of the trials included in this review were of poor quality and were heterogeneous in
terms of interventions, controls, and outcomes measured. With the exception of one outcome in common between two
trials, data were not combined. Therefore, it is still inconclusive whether acupuncture is more effective than sham
acupuncture or other interventions for treating IBS.
Effect of electroacupuncture on visceral hyperalgesia, serotonin and fos expression
in an animal model of irritable bowel syndrome.
Wu JC, Ziea ET, Lao L, Lam EF, Chan CS, Liang AY, Chu SL, Yew DT, Berman BM, Sung JJ.
Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong.
Abstract
BACKGROUND/AIMS: While it is well established that acupuncture relieves somatic pain, its therapeutic effect on
visceral pain such as irritable bowel syndrome (IBS) is unclear. We evaluated the effect of acupuncture in treating
visceral hyperalgesia in an animal model.
METHODS: Sprague-Dawley rats (n = 8 per group) with prior neonatal maternal separation stress were randomly
allocated to receive 3-day treatment of either electroacupuncture (EA) or sham acupuncture at acupoint ST-36.
Another Auriculotherapy stimulation for neuro-rehabilitation.
Oleson T.
Auriculotherapy Certification Institute, 8033 Sunset Blvd., PMB #270, Los Angeles, CA 90046-2427, USA. [email protected]
Abstract
The capability of reflex points on the external ear to alter neuromuscular and neuropathic disorders has been attributed
to the descending pain inhibitory pathways of the central nervous system. The inverted fetus perspective of the
somatotopic arrangement of auricular acupuncture points was first described in the 1950's by Dr. Paul Nogier of France,
and has received scientific support from double blind studies examining auricular diagnosis of musculoskeletal and of
coronary disorders. Acupuncture points on the ear and on the body have lower levels of electrical skin resistance than
surrounding tissue. These electrodermal differences are apparently related to autonomic control of blood vessels rather
than increased sweat gland activity. The heightened tenderness of reactive acupuncture points may be explained by the
accumulation of noxious, subdermal substances. Electrical stimulation of specific points on the external ear leads to site
specific neural responses in different regions of the brain. Behavioral analgesia produced by auricular acupuncture can
be blocked by the opiate antagonist naloxone, indicating the role of endorphinergic systems in understanding the
underlying mechanisms of auriculotherapy. The anatomical structures and electrical application of the auricle are
described as they relate to the localization of master points, musculoskeletal points, internal organ points, and
neuroendocrine points.
group of rats without prior maternal separation was included as non-handled controls. Colorectal distension was
performed on the day after acupuncture treatment. The 3 groups were compared for pain threshold as determined by
abdominal withdrawal reflex and visceromotor response as measured by electromyogram. Colon, spinal cord, and
brainstem were sampled for topographic distribution and quantitative assessment of serotonin and Fos expression by
immunohistochemistry.
RESULTS: Rats in EA group had significantly higher pain threshold compared to those in sham acpuncture group (25.0
+/- 5.7 mmHg vs 18.7 +/- 5.2 mmHg, p = 0.01) and it was comparable with that of non-handled treatment naïve controls
(29.4 +/- 9.3 mmHg, p = 0.28). They also had lower visceromotor response as measured by electromyogram compared
to those received sham acupuncture at all colorectal distension pressures. EA significantly suppressed Fos expression in
doral raphe nuclei of brainstem, superficial dorsal horn of spinal cord and colonic epithelium but suppressed 5-HT
expression only in brainstem and spinal cord.
CONCLUSIONS: Electro acupuncture attenuates visceral hyperlagesia through down-regulation of central serotonergic
activities in the brain-gut axis.
PMID: 20680170 [PubMed - in process]PMCID: PMC2912124Free PMC Article
LinkOut - more resources
[Acupuncture--a complementary treatment in general practice]
[Article in Norwegian]
Aanjesen T, Senstad AC, Lystad N, Kvaerner KJ.
Det medisinske fakultet Universitetet i Oslo 0316 Oslo.
Abstract
BACKGROUND: Acupuncture is the complementary treatment most commonly used by general practitioners. This study
describes the use of acupuncture among Norwegian general practitioners trained in acupuncture.
MATERIAL AND METHODS: By telephone or mail, a questionnaire was presented to 212 general practitioners who had
completed training in complementary acupuncture. They were asked to describe the use and effect of acupuncture and
their attitude towards acupuncture.
RESULTS: Of the 111 physicians who replied (53%), 67 (60%) used acupuncture in their clinical practice. 78% had
acupuncture courses of less than four weeks' duration only. 52% stated that acupuncture was the preferred treatment in
more than 5% of their patients. About 70-80% used acupuncture as a supplement to conventional treatment.
Acupuncture was commonly used in patients with musculoskeletal pain (93%), migraine (66%), and headache (63%),
less often in patients with nausea, allergy, anxiety, sleep disturbances and gastrointestinal disorders. Improvement was
reported in approximately three out of four patients. Lack of time was regarded as the major limitation to the use of
acupuncture.
INTERPRETATION: Many general practitioners trained in complementary acupuncture use acupuncture as an
integrated part of their clinical practice.
Auricular acupuncture and auricular medicine.
Soliman N, Frank BL.
UCLA School of Medicine, Medical Acupuncture for Physicians Program, USA.
Abstract
Auricular acupuncture is a treatment system based on normalizing the body's pain and dysfunction through stimulation of
points on the ear. Resulting amelioration of pain and illness is believed to be through the reticular formation through the
sympathetic and parasympathetic nervous systems. Scalp acupuncture is one of the newest systems of
microacupuncture therapy and anesthesia developed in the People's Republic of China; here the needle is inserted and
stimulated in the areas directly above the corresponding nerve center. Hand acupuncture is a recently developed type of
microreflex system that can be used exclusively or in addition to body acupuncture. Hand acupuncture is indicated to
treat all ailments for which acupuncture is traditionally recommended.
Publication Types, MeSH Terms[Adverse reactions to acupuncture]
[Article in German]
Strzyz H, Ernst G.
Abteilung für Anästhesiologie und Operative Intensivmedizin, Virchow-Klinikum, Berlin.
Abstract
Acupuncture is frequently used as an alternative therapy to drugs in the treatment of pain patients. In this review we
discuss adverse reactions to acupuncture by means of case reports and our own clinical experience. Frequent side
effects of acupuncture are local pain, autonomic nervous system reactions (including fainting) and small local bleeding or
hematomas. There are, however, some case reports of serious adverse reactions. Since 1980, there have been 18
pneumothoraces post acupuncture therapy reported in the literature. Hepatitis due to inadequate hygiene standards has
also been reported. Some patients with valvular heart disease have developed endocarditis after acupuncture. Ear
acupuncture with permanent needles can cause chondritis or perichondritis. For any acupuncture treatment, a careful
case history and exact diagnosis are necessary. In particular, it should be determined whether wound-healing disorders,
immunosuppression, coagulation defects, valvular heart disease or pregnancy are present, as all of these constitute
relative contraindications to acupuncture. Hygiene standards have to be observed. Bearing these points in mind,
acupuncture is a reliable method with few side effects.
PMID: 12799834 [PubMed]
Ear acupuncture has a hypotonic effect on the gastrointestinal tract]
[Article in Serbian]
Borozan S, Petković G.
Vojnomedicinska akademija, Klinika za fizikalnu medicinu i rehabilitaciju, Institut za radiologiju, Beograd.
Abstract
The effect of auricular acupuncture (AAP) on the motility and tone of gastrointestinal tract was investigated in 60 patients,
by comparison of the width of corpus and antrum of the stomach, as well as duodenum before and after the application
of AAP. The obtained results showed that the effects of AAP and usual drugs were equal. The fact that AAP was applied
without any side effects and contraindications pointed to the possibility of its wider application in clinical practice.
[Treatment of esophageal motility disorders with acupuncture of the ear
(preliminary report)]
[Article in Czech]
Hep A, Prásek J, Dolina J, Ondrousek L, Dítĕ P.
III. interní klinika, Brno-Bohunice.
Abstract
Impaired motility of the oesophagus is relatively frequent in patients with functional blocks of the cervical spine. The
patient does not always realize oesophageal dysmotility. Auricular acupuncture focused on reflex relations seems to be a
useful therapeutic procedure.
Ear acupuncture in psychosomatic medicine: the importance of the Sanjiao (triple
heater) area.
Romoli M, Giommi A.
S.I.R.A.A.-Società Italiana di Riflessoterapia, Agopuntura, Auricoloterapia, Prato, Italy.
Abstract
A group of 50 patients with possible psychosomatic disorders of the cardiovascular, respiratory and digestive systems
were treated with Ear acupuncture. Together with a control group of 20 symptomless volunteers they received 4 weekly
treatments and a final check of the therapy after 6 weeks. All subjects were examined with the MMPI test, Paykel's scale
for stressful life events, and with the SRT scale (Symptom Rating Test) for measuring at each treatment the variations of
anxiety, depression and somatisation levels. The results show a similar trend of response to Acupuncture in both groups,
which was significantly more pronounced in the stress group for the reduction of the SRT score and the number of Ear
acupuncture points. The outer ear was sensitized by stress response in certain recurrent areas, especially of the cavum
conchae. The area with the highest relative density of Ear acupoints was the Sanjiao or Triple Heater area.
Recent studies on auriculoacupuncture and its mechanism.
Chen H.
Shanghai Institute of Acupuncture and Moxibustion.
Abstract
This article is based on the review of more than eighty references involving clinical treatment, analgesia, auriculoacupoint
for diagnosis and its mechanism. In the first part, selection of acupoints, methods of manipulation, therapeutic effects and
related experience in 56 kinds of respiratory, circulatory, digestive, urological, gynaecological, obstetrical, pediatric,
otolaryngologic and ophthalmologic, dermatologic diseases and diseases of the nervous systems, as well as treatment of
acute abdominal diseases, reduction of body weight, abstinence from smoking and drinking, etc. are discussed. A variety
of stimulation methods, such as auriculoacupuncture with filform needles, needle embedding therapy, point injection,
bloodletting, laser irradiation, aurioular plaster and pressing therapy, etc are also introduced. In the second part,
experiences of surgical operation and endoscopy under auriculoacupuncture anesthesia are described. The third part
deals with diagnosis using auriculoacupoints. Also described in this part is the clinical application of auricular acupoints in
the diagnosis of cancers, coronary diseases, cholelithiasis, hepatitis, tertian malaria, etc. The correlation between the
morphology and function of auricular acupoints, i.e. the relationship between auricular acupoints and visceral function,
and main development in clinical therapy, diagnosis and mechanism of auriculoacupuncture are introduced in the fourth
part, including the results of investigations of reactions of auriculoacupoints during disorders of the body and viscerae,
reactions of viscerae during stimulation of auriculoacupoints and their transmission routes. Based on the analysis of the
history and current status of research on auriculoacupuncture, the author emphasizes the necessity of attaching
importance at the same time to prophylaxis and treatment of serious diseases and standardization of nomenclature.
Suggestions in this connexion are also made.
MeSH Terms
LinkOut - more resources[The effect of stimulating the auricular liver-gall
point on the size of gallbladder of the rabbit]
Zhang Y, Li Y, Tang X, Ji C, Chen L.
Department of Biology Nanjing University.
Abstract
After stimulating the auricular liver-gall point of rabbit with electrode. We observed marked contraction of gallbladder.
Only one minute after stimulation, the contraction began. About ten minutes after stimulation the contraction was marked
and the contraction lasted for 30-40 minutes. The average product of the length and width of gallbladder (15-25 minutes
after stimulation) is markedly smaller than that of control (pre-stimulation). This result proves the liver-gall point of rabbit
corresponds with its internal organ-gallbladder. The result also present a theoretic basis for clinical therapy of press over
the auricular liver-gall point induced the excretion of gallstones.
[Nondrug methods in the combined treatment of peptic ulcer patients]
[Article in Russian]
Degtiareva II, Kharchenko NV.
Abstract
Use of treatment complexes including non-drug methods (auricular acupuncture, pathogenetic dietotherapy, ILBR) or
reduced doses of modern pharmacopreparations allowed to achieve rapid clinical and endoscopic remission in patients
with ulcer disease. Simultaneously occurs normalization of the aggressive and defensive properties of the gastric juice,
immunological, microcirculatory changes in the body and gastroduodenal mucosa. The vascular laser blood radiation
reduced antacid dose and pathogenetic dietotherapy.
[A study on the effect of stimulating auricular points on the biliary tract]
Zhang Y, Yang K, Yu X, Zhang H, Ye X, Tian J.
Department of Biology, Nanjing University.
Abstract
We have developed an animal model to study the effect of stimulating auricular points on the function of hepato-biliary
system. The preliminary result shows that 14 of 18 rabbits acquired a marked increase (P less than 0.05) in the amount
of heptic bile secretion 3 min and 7 min after point No. 3 stimulated with 58V.
Publication Types, MeSH291 cases of cholelithiasis treated with electric
shock on otoacupoints.
Abstract
PMID: 1861515 [PubMed - inde
Ter[An approach to mechanism of function of auricular point]
Liu W, Xu G.
Institute of Acupuncture and Meridian, Anhui College of T C M, Hefei.
Abstract
mechanism of function of auricular point. Results: In intact car innervation, the changes of gastrointestinal electric activity
on ear needling were obvious (P less than 0.05-0.01). While the one with ear nerve selected showed that influence of ear
acupuncture still remained, but when the whole auricle was denervated the influence of ear needling on gastrointestinal
electric activity obviously deceased or disappeared. pro- and post needing the changes on gastrointestinal electric
activity were not statistically different (P greater than 0.05). Recordings at the four parts of digestive tract gave similar
results in frequency, amplitude, motility index, action area integral. Exerting stimulation on gastric vagus or sympathetic
nerves could bring about double phase modulatory (excitatory or inhibitory). The above revealed that the functions of ear
point in diagnosis and therapy is not due to one kind of nerves in periphery. The functions of ear point at innervation may
be in its entirety. It was reported that function of ear points has something to do with auricular vagus or great auricular or
sympathetic nerves, but, this is only one side of the matter. Moreover, since auricular point are associated with various
propagation tracts and with modulation of nerve centers, their mechanism is very complicated and needs to be further
studies.
PMID: 2125876 [PubMed - indexed for MEDL
The effect of benzodiazepines administration on auricular symptomatological
evidence.
Ceccherelli F, Altafini L, Varotto E, Stefecius A.
Institute of Anesthesiology and Intensive Care, University of Padova, Italy.
Abstract
The aim of this study is to verify the response of auricular skin to interoceptive stimuli in two groups of patients suffering
from a gastroenteral pathology. Patients were submitted to a complete examination of auricle, in order to detect
morphological alterations and painful points, and to a diagnostic digestive endoscopy. A group of patients took
benzodiazepines at the moment of auricular examination; the second group did not take any drug. Results show that
there is a significantly lower number of auricular painful points in the patients taking benzodiazepines in comparison with
the patients who did not take such drug. In the patients treated with benzodiazepines the auricular diagnosis of painful
points does not seem to be reliable.
Reflexotherapeutic effects on biologically active points of the concha auriculae]
[Article in Russian]
Kiseleva RE, Pishkov VN, Shirokova TIu, Shabanov AN, Sosunov AA.
Abstract
By means of histochemical method, for revealing cholinergic nervous structures, and electron microscopy, innervation of
biologically active points (BAP) and that of neutral areas of the rabbit ear skin has been studied, normal and after acu-,
electro- and electroacupuncture. The BAP have more intensive vascularization and innervation, their specific feature is
presence of well pronounced nervous fasciculi. The latter are formed by 6-10 fibers 1-6 mcm in diameter. The diameter
of the fasciculi is within the limits 25-30 mcm up to 40-45 mcm. Under the electron microscopic investigation myelin and
amyelin fibers are revealed in the nervous fasciculi. In the area of the epidermal basal layer and in the epidermis itself,
single nerve terminals are found; they are considered as the point pain receptors. After acu-, electro- and
electroacupuncture, intensity of the nervous fibers staining increases, thus demonstrating an increment of acetylcholine
esterase activity. After insertion of acupuncture needles and after electrical irritation, the changes in the nervous and
cellular elements in the BAP areas are studied electron microscopically. After the effects mentioned, mast cells situating
in the BAP area become, as a rule, degranulated. After repeated electroacupuncture irritation of the BAP, an
inflammatory focus appears with peculiarities specific for the given process. The reflexotherapeutic effect is supposed to
be transferred via the nervous system. The mechanical irritation of the nerve fasciculi and the accompanying
traumatization of the surrounding cellular elements initiate the mechanism of reflexotherapy.
Comparison of the diagnostic possibilities of palpation of the abdominal cavity and
ear acupuncture in diseases of the gastrointestinal tract in dogs]
[Article in Czech]
Still J, Konrád J.
Abstract
The diagnostic possibilities of the use of palpation and auriculodiagnosis were compared in 89 and 78 dogs with clinical
signs of gastritis acuta, gastroenteritis acuta, and gastroenteritis acuta haemorrhagica. A significant difference in the
success of diagnosis in favour of auriculodiagnosis was confirmed by the statistical evaluation of the results. The best
results were obtained when gastritis acuta was diagnosed: auriculodiagnosis was successful in 100% of the cases, in
contrast to palpation which was successful in 33.3% of the cases. The objectivity of detection painfulness and the
decrease of relative skin resistance were secured by the use of an atraumatic electrode. The results which are of primary
importance in veterinary medicine agree with similar findings in human clinical acupuncture.
Publication Types, MeSH Terms
Results: 721 to 735 of 735
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Ricerche di esempio
Constipation
To cite this article:
Mei-Kuen Li, Tze-Fan D. Lee, Kwai-Ping L. Suen. The Journal of Alternative and Complementary Medicine.
April 2010, 16(4): 435-447. doi:10.1089/acm.2009.0348.
Background: Constipation is a common health problem that adversely affects an individual's general health
and quality of life. Constipated people usually manage the problem by taking laxatives and by modifying their
lifestyle even if such have questionable therapeutic effects. Auriculotherapy, a safe treatment modality in
Chinese medicine, has been reported to be effective in managing constipation. Despite previous studies
reported encouraging results in using auriculotherapy, its effectiveness in managing constipation has not
been systematically reviewed. This review, therefore, examines previous studies that have investigated the
effectiveness of auriculotherapy in managing constipation.
Method: A search in the databases of MEDLINE,® EMBASE, AMED, and China Academic Journals Full-text
Database and manual searching were performed to identify relevant clinical studies.
Results: A total of 29 relevant clinical studies conducted from 1994 to 2008 were identified. All of the studies
reported that auriculotherapy was effective in managing constipation. However, generalization of their
findings was limited because of two significant methodological flaws: (1) uncertainty in accurate acupoints
identification and subjects' compliance to instructions resulted in varied doses of intervention received; and
(2) inconsistent intervention protocols and therapeutic outcome criteria made comparison among different
studies difficult.
Conclusions: The findings of this review could provide pertinent information for researchers in terms of
study designs and methodologies that may be used for future studies. The use of randomized controlled
trials on a sample of sufficient size and of standard intervention protocol is recommended to provide
empirical evidence that will support auriculotherapy as a complementary strategy in managing constipation.
Le localizzazioni auricolari dell’apparato digerente sono state dimostrate da
Portonov di Riga (URSS) 1980-87 mediante le variazioni dell’impedenza dei
punti auricolari in relazione a stimoli su organi interni nell’animale da
esperimento(cane e coniglio).Altri autori Jan Z. Szopinski ed altri,hanno
dimostrato l’area di proiezione dello stomaco e del duodeno nel monitoraggio
dell’ulcera peptica oltre all’area di proiezione auricolare del fegato per
monitorare dell’epatite virale.
Localizzazioni auricolari dell’apparato digerente :
Punto bocca (cavità orale) funzionale patologico bilaterale per patologie
della cavità orale palato molle ,gengiva e lingua .Situato nella conca riduce
mediamente:
Azione :Prevenzione attacchi di panico.
Detezione : Elettrica-Baroestesica.
Punto esofago e cardias funzionale e patologico bilaterale per patologie
esofagee ,reflusso esofageo e nausea.
Situato nella conca ridge terzo prossimale e laterale.
Detezione :Elettrica e Baroestesica.
Punto stomaco funzionale patologico bilaterale per patologie
gastriche,nausea,vomito,comportamento alimentare e MTC. Situato alla
sommità laterale della conca ridge.
Detezione :elettrica e baroestesica.
Punto intestino tenue funzionale e patologico bilaterale per patologie del
tenue ,diarrea e distensione addominale.
Situato nella porzione inferiore della conca superiore lateralmente.
Detezione:Elettrica e Baroestesica.
Punto intestino crasso funzionale e patologico bilaterale per patologie del
colon ,diarrea,distensione addominale e stipsi.
Punto retto (ano,P. emorroidario) funzionale bilaterale per patologie del
retto ,stipsi ed emorroidi.
Punto appendice destro funzionale e patologico per appendicite acuta e
cronica con tre punti situati nel solco interno della fossa scafoidea.
Detezione :Elettrica e Baroestesica
Punto Fegato (liver) bilaterale patologico per MTC,patologie
epatiche,patologie dei muscoli e dei tendini,cefalee ,vertigini ed azione
psichica.
Per la scuola cinese area fegato medialmente sotto l’antelice nella porzione
media della conca superiore ed inferiore punto Epatite e punto Rilassamento
vicino a milza e punto Sanjiao.
Punto Plesso Solare(plesso celiaco) bilaterale punto Zero per patologie
apparato digerente ed Azione spasmolitica.
Punto Cistifellea destro patologico per patologie della
colecisti,nausea,MTC e cefalea,tinnito e vertigini.
Punto pancreas sinistro patologico per patologie del pancreas ,turbe
dispeptiche e diabete mellito.
Detezione:elettrica e baroestesica.
Punto sintomatico stipsi bilaterale.
Insieme di punti di somatizzazioni apparato digerente situati sulla
stessa linea verticale Omega 1 al centro sulla porzione Helice 1 ,Omega
2 sulla porzione ascendente dell’elice e Omega 3 Master Omega(Master
cerebrale F,Neuroastenia C) sul lobo auricolare area 4.
I passaggi sono:
Formulazione Protocollo terapeutico.
Insieme specifici.
Punti singoli.
Punti rappresentazione auricolare sede delle lesioni.
Le applicazioni terapeutiche dopo la diagnosi clinica comprende la
scelta di.
-Punti funzionali di I° livello
-Punti funzionali di II° livello
MASTER POINT
PUNTI DELLA MTC
PUNTI SINTOMATICI
PUNTI PSICHICI
-Punti con corrispondenza anatomica.
CONCLUSIONI
Dalla letteratura si evince che il ruolo della CAM ed in
particolare dell’auriculoterapia può essere quello di
fare parte del bagaglio del medico di estrazione
occidentale per trattare disturbi funzionali
stipsi,diarrea ,discinesie delle vie biliari e della motilità
gastrointestinale e di sintomi secondari a
chemioterapia.
Per quanto riguarda il reflusso biliare con o senza
colecistectomia i punti evocabili si localizzano in periferia
andando a coprire le zone di proiezione del fegato,delle vie
biliari,ed in parte dell’esofago.
Entrando nella conca inferiore ,subito sotto la radice
dell’elice ,troviamo alcuni punti relativi all’apparato digerente
superiore e sono la proiezione del cardias,dell’esofago e
della bocca.
In caso di reflusso gastroesofageo si può osservare una
tipica iperemia sotto la radice dell’elice ;in corrispondenza
dell’incisura elicotragica che si trova la bocca .Per quanto
riguarda le patologie disfunzionali dell’apparato
gastrointestinale, l’auriculoterapia si può rivelare
utile nella riduzione della stipsi secondaria alla
somministrazione di oppiacei, che spesso
provocano un rallentamento significativo della
peristalsi gastro-intestinale: in questo caso la
stimolazione degli agopunti sull’orecchio è in
grado di migliorare la digestione e ridurre
l’anoressia secondaria.
Occorre tenere presente la necessità di una corretta
diagnosi basata sulla metodologia occidentale clinica
e strumentale.
Alla diffusione dell’auriculoterapia possono contribuire
lavori di ricerca clinica e sperimentale secondo i criteri
esposti in questa tesi.

UMAB Unione Medici Agopuntori Bresciani GSATN Scuola

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