Акупунктура

[Artemij Okhotin]

Вы бы правку внесли, а то читать невозможно.

[Igor Simonov]

Numerous scientific studies have confirmed
this judgment, and it's now widely
accepted in medical circles that acupuncture
is an effective treatment for most types
of pain. In countries around the
world, acupuncture is becoming a bona
fide treatment for pain- another tool, along
with painkillers and anesthetics, in the doctor's
medical kit.
"I think it's funny," he says, "that with all this
modern science, we cannot explain this
thing. Nobody knows the mechanism."
Medicine, of course, is a pragmatic profession.
Physicians and patients don't care
so much about the why, as long as it works
and has no side effects.
More than
2,OOO acupuncturists are licensed in
France-medical doctors u'hose services are
reimbursed bv the state health system. In
Germany, 50,000 physicians practice acupuncture,
and the numbers are rising. Most
hospitals and pain-treatment clinics include
acupuncture as a standard regimen. And the
government is currently funding clinical trials
on 150,O00 patients suffering from chronic
back pain, migraines and athritis, as a
prelude to making acupuncture a part of the
country's health service later this year. Even
some private health insurers in the United
States now offer at least patial reimbursement
for acupuncture fteatments.
Perhaps the clearest sign that acupuncture
has made it big in Western medicine is
that it's being used to cut health-care costs.
"Acupuncture doesn't fit with arything I
learned at university," says Tassani. "All I
know is, it works." For the art of medicine,
that's as good as it gets.

[Igor Simonov]

The World Health Organization acknowledges its indebtedness to the experts who participated in the WHO Consultation on Acupuncture held in Cervia, Italy in 1996, at which the selection criteria for the data included in this publication were set. Special thanks are due to Dr Zhu-Fan Xie, Honorary Director of the Institute of Integrated Medicines, First Hospital of Beijing Medical University, China, who drafted, revised and updated this report. Further, Dr Xie made numerous Chinese language documents available in English. We also thank Dr Hongguang Dong, Geneva University Hospital, Switzerland for providing additional information.
Appreciation is extended to the Norwegian Royal Ministry of Health and Social Affairs for providing the financial support to print this review.
Evaluation methodology
Unlike the evaluation of a new drug, controlled clinical trials of acupuncture are extremely difficult to conduct, particularly if they have to be blind in design and the acupuncture has to be compared with a placebo. Various “sham” or “placebo” acupuncture procedures have been designed, but they are not easy to perform in countries such as China where acupuncture is widely used. In these countries, most patients know a great deal about acupuncture, including the special sensation that should be felt after insertion or during manipulation of the needle. Moreover, acupuncturists consider these procedures unethical because they are already convinced that acupuncture is effective. In fact, most of the placebo-controlled clinical trials have been undertaken in countries where there is scepticism about acupuncture, as well as considerable interest.
A more practical way to evaluate the therapeutic effect of acupuncture is to compare it with the effect of conventional therapy through randomized controlled trials or group studies, provided that the disease conditions before treatment are comparable across the groups, with outcome studies developed for all patients.
Because of the difficulty of ruling out the placebo effect, a comparative study with no treatment as the control may not be convincing in the evaluation of acupuncture practice. Retrospective surveys, in which the effect of acupuncture therapy is compared with past treatments, may not be of significance either, particularly if they have not been well designed. Non-comparative studies are certainly of little significance, particularly when acupuncture is used for the treatment of a self-limited disease. However, if rapid improvement can be achieved in the treatment of a long-standing, chronic disease, or if there is definite improvement in a disease that is generally recognized as intractable to conventional treatment, the effect of acupuncture should be viewed in a more favourable light, even when a well-designed, controlled study has not been carried out.
Another difficulty in evaluating acupuncture practice is that the therapeutic effect depends greatly on the proficiency of the acupuncturists—their ability and skill in selecting and locating the acupuncture points and in manipulating the needles. This may partly explain the disparities or inconsistencies in the results reported by different authors, even when their studies were carried out on equally sound methodological bases.
Evaluating acupuncture practice and arriving at generally accepted conclusions is no easy task, therefore. While effectiveness is doubtless of the utmost importance, other factors, including safety, cost, availability and the condition of local health services must also be considered. Given the same effectiveness, these other factors may lead to different evaluations of acupuncture in different countries and areas. However, conclusions are needed that apply to worldwide use, particularly for countries and areas where proper development of acupuncture practice would bring a great deal of benefit. Evaluations should not therefore be confined to those diseases for which modern conventional treatments are inadequate or ineffective.
Because of the success of surgical procedures carried out under acupuncture analgesia, the treatment of pain with acupuncture has been extensively studied. For other conditions often treated with acupuncture, there are fewer reports that have adequate methodology.
1.4 Safety
Generally speaking, acupuncture treatment is safe if it is performed properly by a well-trained practitioner. Unlike many drugs, it is non-toxic, and adverse reactions are minimal. This is probably one of the chief reasons why acupuncture is so popular in the treatment of chronic pain in many countries. As mentioned previously, acupuncture is comparable with morphine preparations in its effectiveness against chronic pain, but without the adverse effects of morphine, such as dependency.
Even if the effect of acupuncture therapy is less potent than that of conventional treatments, acupuncture may still be worth considering because of the toxicity or adverse effects of conventional treatments. For example, there are reports of controlled clinical trials showing that acupuncture is effective in the treatment of rheumatoid arthritis (4–6), although not as potent as corticosteroids. Because, unlike corticosteroids, acupuncture treatment, does not cause serious side-effects, it seems reasonable to use acupuncture for treating this condition, despite the difference in effectiveness.
1.5 Availability and practicability
The availability and practicability of acupuncture are also important factors to consider. The advantages of acupuncture are that it is simple, convenient and has few contraindications. Although the success rate of acupuncture therapy in treating kidney stones, for example, is confirmed by comparative studies with other therapies (7), it is by no means as high as that of surgical intervention. However, acupuncture treatment of kidney stones is still worth recommending because of its simplicity, which makes it more acceptable to patients.
There are also instances where acupuncture is not more practicable than conventional therapy. For example, the effectiveness of acupuncture treatment of acute bacillary dysentery has been shown to be comparable with that of furazolidone (8–10), but this is of rather academic significance because oral administration of furazolidone or other antidysenteric drugs is more convenient.
The conditions of the health service in a given country or area should also be considered in evaluating acupuncture practice. In developing countries, where medical personnel and medicines are still lacking, the need for acupuncture may be considerable and urgent; proper use of this simple and economic therapy could benefit a large number of patients. On the other hand, in developed countries, where the health system is well established, with sophisticated technology, adequate personnel and a well-equipped infrastructure, acupuncture might be considered to be of great value in only a limited number of conditions. It could still serve as a valuable alternative treatment for many diseases or conditions for which modern conventional treatments are unsuccessful. It is also valuable in situations where the patient is frightened of the potential risks or adverse effects of modern conventional treatments. In fact, in some developed countries, the diseases for which patients seek help from acupuncturists tend to be beyond the scope of orthodox medicine.

[Igor Simonov]

1.6 Studies on therapeutic mechanisms
Clinical evaluations indicate whether the therapy works; research on the mechanisms involved indicates how it works and can also provide important information on efficacy. Knowing that acupuncture is effective and why makes the practitioner confident in its use, and also allows the technique to be used in a more appropriate way.
The clinical evaluation may precede studies on the mechanisms, or vice versa. For acupuncture, in most instances the clinical effect has been tested first. Use of the technique may then be further expanded on the basis of the results of research on the mechanisms. For example, experimental studies of the effect of acupuncture on white blood cells led to a successful trial of the treatment of leukopenia caused by chemotherapy.
To date, modern scientific research studies have revealed the following actions of acupuncture:
• inducing analgesia
• protecting the body against infections
• regulating various physiological functions.
In reality, the first two actions can also be attributed to the regulation of physiological functions. The therapeutic effects of acupuncture are thus brought about through its regulatory actions on various systems, so that it can be regarded as a nonspecific therapy with a broad spectrum of indications, particularly helpful in functional disorders. Although it is often used as a symptomatic treatment (for pain, for instance), in many cases it actually acts on one of the pathogenic links of a disease.
Although different acupuncture points and manipulations may have an effect through different actions, the most important factor that influences the direction of action is the condition of the patient. Numerous examples reveal that the regulatory action of acupuncture is bi-directional. Acupuncture lowers the blood pressure in patients with hypertension and elevates it in patients with hypotension; increases gastric secretion in patients with hypoacidity, and decreases it in patients with hyperacidity; and normalizes intestinal motility under X-ray observation in patients with either spastic colitis or intestinal hypotonia (11). Therefore, acupuncture itself seldom makes the condition worse. In most instances, the main danger of its inappropriate application is neglecting the proper conventional treatment.
Since its therapeutic actions are achieved by mobilization of the organism’s own potential, acupuncture does not produce adverse effects, as do many drug therapies. For example, when release of hydrocortisone plays an important role in the production of a therapeutic effect, the doses of this substance released by acupuncture are small and finely regulated, thereby avoiding the side-effects of hydrocortisone chemotherapy (12). On the other hand—and for the same reason—acupuncture has limitations. Even under conditions where acupuncture is indicated, it may not work if the mobilization of the individual’s potential is not adequate for recovery.
1.7 Selection of clinical trial reports
In recent decades, numerous clinical trials have been reported; however, only formally published articles that meet one of the following criteria are included in this review:
• randomized controlled trials (mostly with sham acupuncture or conventional therapy as control) with an adequate number of patients observed;
• nonrandomized controlled clinical trials (mostly group comparisons) with an adequate number of patients observed and comparable conditions in the various groups prior to treatment.
In many published placebo-controlled trials, sham acupuncture was carried out by needling at incorrect, theoretically irrelevant sites. Such a control really only offers information about the most effective sites of needling, not about the specific effects of acupuncture (13). Positive results from such trials, which revealed that genuine acupuncture is superior to sham acupuncture with statistical significance, provide evidence showing the effectiveness of acupuncture treatment. On the other hand, negative results from such trials, in which both the genuine and sham acupuncture showed considerable therapeutic effects with no significant difference between them, can hardly be taken as evidence negating the effectiveness of acupuncture. In the latter case, especially in treatment of pain, most authors could only draw the conclusion that additional control studies were needed. Therefore, these reports are generally not included in this review.
The reports are first reviewed by groups of conditions for which acupuncture therapy is given (section 2). The clinical conditions covered have then been classified into four categories (section 3):
1. Diseases, symptoms or conditions for which acupuncture has been proved—through controlled trials—to be an effective treatment.
2. Diseases, symptoms or conditions for which the therapeutic effect of acupuncture has been shown, but for which further proof is needed.
3. Diseases, symptoms or conditions for which there are only individual controlled trials reporting some therapeutic effects, but for which acupuncture is worth trying because treatment by conventional and other therapies is difficult.
4. Diseases, symptoms or conditions in which acupuncture may be tried provided the practitioner has special modern medical knowledge and adequate monitoring equipment.
Section 4 provides a tabulated summary of the controlled clinical trials reviewed, giving information on the number of subjects, the study design, the type of acupuncture applied, the controls used and the results obtained.

[Igor Simonov]

2.1 Pain
The effectiveness of acupuncture analgesia has already been established in controlled clinical studies. As mentioned previously, acupuncture analgesia works better than a placebo for most kinds of pain, and its effective rate in the treatment of chronic pain is comparable with that of morphine. In addition, numerous laboratory studies have provided further evidence of the efficacy of acupuncture’s analgesic action as well as an explanation of the mechanism involved. In fact, the excellent analgesic effects of acupuncture have stimulated research on pain.
Because of the side-effects of long-term drug therapy for pain and the risks of dependence, acupuncture analgesia can be regarded as the method of choice for treating many chronically painful conditions.
The analgesic effect of acupuncture has also been reported for the relief of eye pain due to subconjunctival injection (14), local pain after extubation in children (15), and pain in thromboangiitis obliterans (16).
2.1.4 Biliary and renal colic
Acupuncture is suitable for treating acute pain, provided the relief of pain will not mask the correct diagnosis, for which other treatments may be needed. Biliary and renal colic are two conditions for which acupuncture can be used not only as an analgesic but also as an antispasmodic. In controlled studies on biliary colic (62–64) and renal colic (7, 65, 66), acupuncture appears to have advantages over conventional drug treatments (such as intramuscular injection of atropine, pethidine, anisodamine (a Chinese medicine structurally related to atropine, isolated from Anisodus tanguticus), bucinnazine (also known as bucinperazine) or a metamizole–camylofin combination). It provides a better analgesic effect in a shorter time, without side-effects. In addition, acupuncture is effective for relieving abdominal colic, whether it occurs in acute gastroenteritis or is due to gastrointestinal spasm (67).2.1.5 Traumatic or postoperative pain
For traumas such as sprains, acupuncture is not only useful for relieving pain without the risk of drug dependence, but may also hasten recovery by improving local circulation (68–70). Acupuncture analgesia to relieve postoperative pain is well recognized and has been confirmed in controlled studies (71–76). The first successful operation under acupuncture analgesia was a tonsillectomy. This was, in fact, inspired by the success of acupuncture in relieving post-tonsillectomy pain. Post-tonsillectomy acupuncture was re-evaluated in a controlled study in 1990, which not only showed prompt alleviation of throat pain, but also reduction in salivation and promotion of healing in the operative wound (76).
2.1.8 Surgery
Acupuncture analgesia has the following advantages in surgical operations. It is a very safe procedure compared with drug anaesthesia; no death has ever been reported from acupuncture analgesia. There is no adverse effect on physiological functions, whereas general anaesthesia often interferes with respiration and blood pressure, for example. There are fewer of the postoperative complications that sometimes occur after general anaesthesia, such as nausea, urinary retention, constipation, and respiratory infections. The patient remains conscious and able to talk with the medical team during the operation so that injury of the facial and recurrent laryngeal nerve can be avoided. However, remaining conscious may be a disadvantage if the patient cannot tolerate the emotional stress of the procedure.

[Igor Simonov]

2.6 Blood disorders
Among various blood disorders, leukopenia is the most suitable for acupuncture treatment. In controlled studies, acupuncture has been shown to be more effective than batilol and/or cysteine phenylacetate in the treatment of leukopenia due to chemotherapy (140–142) or benzene intoxication (143, 144).
2.7 Urogenital disorders
Urinary retention due to functional disorders, with no organic obstruction, is often treated with acupuncture. For postpartum or postoperative urinary retention, successful micturition usually occurs immediately after one session of needling (66, 145). It is probably for this reason that controlled studies on this subject have been neglected. However, there has been a report of a randomized controlled trial on traumatic retention of urine, a condition more complicated than postpartum or postoperative retention. In this trial, the efficacy of acupuncture was remarkably superior to that of intramuscular injection of neostigmine bromide(146).
Acupuncture is not only useful for relieving renal colic, but also for expelling urinary stones (if they are not too large), because it dilates the ureter. Satisfactory results have been obtained in comparisons with conventional medication (7), but it is better to use acupuncture as a complementary measure in conjunction with medication or lithotripsy.
Sexual disorders are often treated with acupuncture, but conclusive results based on methodologically sound clinical studies are still lacking. Acupuncture was shown to be more effective than placebo in the treatment of non-organic male sexual dysfunction, but the improvement was not statistically significant (147). In another randomized controlled trial, acupuncture had a better effect than the control in the treatment of defective ejaculation (no ejaculation during intercourse) (148).
Acupuncture may also be helpful to patients with chronic prostatitis. As shown in a randomized controlled trial, acupuncture was superior to oral sulfamethoxazole in relieving symptoms and improving sexual function (149).
In women, it has been shown that acupuncture can lower urethral pressure and relieve urethral syndrome (150, 151). Acupuncture has also been successfully used as a prophylaxis against recurrent lower urinary tract infections (152).
2.8 Gynaecological and obstetric disorders
Primary dysmenorrhoea, a painful condition, is one of the major indications for acupuncture in the field of gynaecological disorders. The beneficial effect of acupuncture on this condition has been repeatedly reported in controlled trials (153, 154). Acupuncture relieves pain and also regulates the motility of the uterus to facilitate menstrual discharge and further alleviate the pain.
Premenstrual syndrome is characterized by cyclical mood changes and is a common condition in women of fertile age. Acupuncture seems to be helpful to patients with this syndrome. In a controlled study, the majority of the patients receiving acupuncture gained relief from symptoms and no recurrence in the six-month follow-up (155).
Although acupuncture was reported to be effective in the treatment of female anovular infertility (156), no methodologically sound, controlled trials have been reported. However, the mechanism of acupuncture in regulating abnormal function of the hypothalamic–pituitary–ovarian axis has been demonstrated in experimental studies. The data suggest that electric acupuncture with relative specificity of acupuncture points could influence some genetic expression in the brain, thereby normalizing the secretion of certain hormones, such as gonadotropin-releasing hormone, luteinizing hormone and estradiol (157). Acupuncture is also worth trying in the treatment of female infertility due to inflammatory obstruction of the fallopian tubes, where it seems to be superior to conventional therapy with intrauterine injection of gentamicin, chymotrypsin and dexamethasone (158).
Acupuncture in pregnant women should be undertaken with care. Needling at some points (namely, on the abdomen and lumbosacral region), as well as strong stimulation of certain distant points, such as hégŭ (LI4), sānyīnjiāo (SP6) and zhìyīn (BL67), may cause miscarriage. However, this action is useful if induction of labour is desired, such as in prolonged pregnancy; the effect is comparable with that of oxytocin by intravenous drip (159–161).
In early pregnancy, acupuncture at the upper limb points can be used for the prevention and treatment of morning sickness. The efficacy of acupressure at nèiguān (PC6) has been reported repeatedly in placebo-controlled studies (13, 162, 163). In order to prevent miscarriage induced by needling, acupressure is recommended for the treatment of morning sickness.
Various methods of acupuncture, such as pressure at ear points and moxibustion at zhìyīn (BL67) or zúlínqí (GB41), have been used to correct abnormal fetal position during the last three months of pregnancy. The success rates in groups treated with these methods were much higher than the occurrence of spontaneous version or in groups treated with knee-chest position or moxibustion at non-classical points (164–167).
Acupuncture stimulates milk secretion after childbirth and can be used to treat deficient lactation due to mental lability or depression. It has been observed that acupuncture elevates the blood prolactin level in women with deficient milk secretion after childbirth; in the majority of cases, lactation starts as the blood prolactin level increases (168). The clinical use of acupuncture to promote lactation has also been demonstrated in a randomized controlled study

[Igor Simonov]

2.14 Cancers
No controlled study has been reported on the efficacy of acupuncture in the treatment of cancer itself. However, acupuncture still has uses in cancer treatments. One is to relieve cancer pain, and the other is to control the adverse reactions to radiotherapy and chemotherapy. For cancer pain, it has been reported that acupuncture provided an immediate analgesic effect similar to that of codeine and pethidine, with a more marked effect after use for two months (230). The effect was comparable with that achieved using the analgesic steps recommended by WHO (231). For radiotherapy and chemotherapy, acupuncture can greatly lessen the adverse reactions in the digestive and nervous systems, as well as providing protection against damage to haematopoiesis (232–237).
1. Diseases, symptoms or conditions for which acupuncture has been proved—through controlled trials—to be an effective treatment:
Adverse reactions to radiotherapy and/or chemotherapy
Allergic rhinitis (including hay fever)
Biliary colic
Depression (including depressive neurosis and depression following stroke)
Dysentery, acute bacillary
Dysmenorrhoea, primary
Epigastralgia, acute (in peptic ulcer, acute and chronic gastritis, and gastrospasm)
Facial pain (including craniomandibular disorders)
Headache
Hypertension, essential
Hypotension, primary
Induction of labour
Knee pain
Leukopenia
Low back pain
Malposition of fetus, correction of
Morning sickness
Nausea and vomiting
Neck pain
Pain in dentistry (including dental pain and temporomandibular dysfunction)
Periarthritis of shoulder
Postoperative pain
Renal colic
Rheumatoid arthritis
23
Acupuncture: review and analysis of controlled clinical trials Sciatica
Sprain
Stroke
Tennis elbow

[Igor Simonov]

2. Diseases, symptoms or conditions for which the therapeutic effect of acupuncture has been shown but for which further proof is needed:
Abdominal pain (in acute gastroenteritis or due to gastrointestinal spasm)
Acne vulgaris
Alcohol dependence and detoxification
Bell’s palsy
Bronchial asthma
Cancer pain
Cardiac neurosis
Cholecystitis, chronic, with acute exacerbation
Cholelithiasis
Competition stress syndrome
Craniocerebral injury, closed
Diabetes mellitus, non-insulin-dependent
Earache
Epidemic haemorrhagic fever
Epistaxis, simple (without generalized or local disease)
Eye pain due to subconjunctival injection
Female infertility
Facial spasm
Female urethral syndrome
Fibromyalgia and fasciitis
Gastrokinetic disturbance
Gouty arthritis
Hepatitis B virus carrier status
Herpes zoster (human (alpha) herpesvirus 3)
Hyperlipaemia
Hypo-ovarianism
Insomnia
Labour pain
Lactation, deficiency
Male sexual dysfunction, non-organic
Ménière disease
24
3. Disease and disorders that can be treated with acupuncture Neuralgia, post-herpetic
Neurodermatitis
Obesity
Opium, cocaine and heroin dependence
Osteoarthritis
Pain due to endoscopic examination
Pain in thromboangiitis obliterans
Polycystic ovary syndrome (Stein–Leventhal syndrome)
Postextubation in children
Postoperative convalescence
Premenstrual syndrome
Prostatitis, chronic
Pruritus
Radicular and pseudoradicular pain syndrome
Raynaud syndrome, primary
Recurrent lower urinary-tract infection
Reflex sympathetic dystrophy
Retention of urine, traumatic
Schizophrenia
Sialism, drug-induced
Sjögren syndrome
Sore throat (including tonsillitis)
Spine pain, acute
Stiff neck
Temporomandibular joint dysfunction
Tietze syndrome
Tobacco dependence
Tourette syndrome
Ulcerative colitis, chronic
Urolithiasis
Vascular dementia
Whooping cough (pertussis)

[Igor Simonov]

3. Diseases, symptoms or conditions for which there are only individual controlled trials reporting some therapeutic effects, but for which acupuncture is worth trying because treatment by conventional and other therapies is difficult:
Chloasma
Choroidopathy, central serous
25
Acupuncture: review and analysis of controlled clinical trials Colour blindness
Deafness
Hypophrenia
Irritable colon syndrome
Neuropathic bladder in spinal cord injury
Pulmonary heart disease, chronic
Small airway obstruction
4. Diseases, symptoms or conditions for which acupuncture may be tried provided the practitioner has special modern medical knowledge and adequate monitoring equipment:
Breathlessness in chronic obstructive pulmonary disease
Coma
Convulsions in infants
Coronary heart disease (angina pectoris)
Diarrhoea in infants and young children
Encephalitis, viral, in children, late stage
Paralysis, progressive bulbar and pseudobulbar

[Igor Simonov]

Данную статью можно заказать и прочесть полностью на [Ссылки доступны только зарегистрированным пользователям ]
или я могу её выслать на Ваш мэйл бесплатно

Здравствуйте, Игорь!
К сожалению, не знаю Вашего Отчества.
Если Ваше желание пообщаться с врачами, стремящимися к классике, не прошло, а точнее, если Ваш адрес работает - ответьте.
С уважением, Колдаев А. И.
home@koldaev.ryazan.ru

[Igor Simonov]

[Ссылки доступны только зарегистрированным пользователям ]

[Hard]

Уважаемый Igor Simonov,
как это Вы с таким опытом и попались на очередную кимбохановщину?

[Igor Simonov]

Уважаемый Hard, а с чем Вы не согласны, объяснитесь, пожалуйста, был бы Вам очень признателен.

С уважением Игорь Симонов

недавно слышал об акупунктурных иглах высокого качества московского производства. не подскажете ли, где их можно приобрести?