Clinical reasoning in traditional medicine exemplified by the clinical encounter of Korean medicine: a narrative review.

BACKGROUND: Clinical reasoning is generally defined to be a way of thinking for diagnostic or therapeutic decision making in clinical practice. Different cognitive models have been proposed for the clinical reasoning which takes place during the clinical encounter with a patient. This may have similarities with similar approaches used in Traditional Korean Medicine (TKM). Jinchal, the clinical encounter, has specific features in TKM and different Jinchal processes are closely related to several underlying cognitive models in clinical reasoning. It is a necessary process to see the patient, but in TKM, the method has a characteristic aspect and emphasis is placed on importance. METHODS: Experts consensus were reached through panel discussion. Narrative description on the concept of clinical reasoning and explanation on Jinchal process in TKM were suggested. RESULTS: This article analyses the Jinchal process using theoretical concepts from four authentic KM schools of clinical reasoning which are currently used in contemporary practice. CONCLUSION: Future research should focus on the similarities and differences in understanding clinical reasoning in KM as well as the broader field of traditional East Asian Medicine.

Acupuncture as a Treatment Within Integrative Health for Palliative Care: A Brief Narrative Review of Evidence and Recommendations.

Background: Acupuncture is one of the fastest developing evidence bases in Complementary Medicine and is one of the leading therapies included within integrative health care. This narrative review includes two separate parts: the first is about evaluation of the current evidence status in reviews on acupuncture and the second examines and gives examples of available recommendations on acupuncture in treatment guidelines from health care experts and public health organizations recommending acupuncture as a viable treatment in patients in palliative care. Methods: Electronic searches were performed in PubMed using the terms "acupuncture" + "palliative" and adding the term "safety" to find review articles documenting safety and evidence of effectiveness of acupuncture for treatment of symptoms in palliative care patients. Treatment guidelines that recommend use of acupuncture for symptom control in palliative care were found by searching through a database currently under construction by the lead author. Results: Acupuncture shows emerging evidence for 17 indications in palliative care. Examples were found and presented of publications recommending acupuncture for treatment of symptoms for patients in palliative care from Government, public health, oncology, and medical expert sources. The most publications are in oncology, but other conditions were found and a number were found in pediatric care. Conclusions: While the evidence for use of acupuncture to treat symptoms in palliative care patients is relatively weak, the evidence base is growing. Experts worldwide are also increasingly recommending acupuncture as a treatment for symptoms in palliative care. Since acupuncture is a safe, nonpharmacological treatment but with small, clinically significant effects, these recommended uses appear as pragmatic efforts to bridge the gap of treatment options available to this patient group.

Chinese herbal medicine for treating menopausal symptoms in London women: developing a good practice protocol via the factor analysis of prescribing patterns in a clinical study.

The objective of the study described in this paper was to define Chinese medicine formula patterns for the treatment of menopausal women in London. These formula patterns are intended to inform the development of best practice guidelines for a future pragmatic randomised controlled trial, with the ultimate goal of evaluating the possibility of integrating Chinese medicine treatment strategies for menopausal symptoms into the UK National Health Service. Data from a clinical study that had demonstrated the effectiveness and safety of Chinese medicine in treating 117 perimenopausal women at the Westminster University Polyclinic in London were analysed for symptom occurrence and herb use. The frequency of occurrence of different presenting symptoms and the frequency of use of individual herbs is described, the patterns of combined herb use were analysed by means of factor analysis, and the correlations between these patterns and the presenting symptoms were analysed using the chi square test. Treating the emergent use patterns as Chinese herbal medicine formulas, five distinctive formula patterns emerged in the course of this study. While there is some overlap between these formulas and their associated symptom patterns and those described in Chinese medicine textbooks and guidelines, some formula patterns appear to be unique to London women. This indicates that best practice guidelines for the Chinese medicine treatment of menopausal symptoms, which have been shown to vary cross-culturally, need to be derived from local clinical practice.

An international survey on the current use of electroacupuncture.

BACKGROUND: Despite many research publications, it is unclear how widely electroacupuncture (EA) and related modalities are used in everyday practice. It is also uncertain who uses them, for what conditions, and with what results. We aimed to survey practitioners about their use of and training in EA. We also sought to determine how much the open-access English-language database at http://www.electroacupunctureknowledge.com (EAK) is used, or might be used in the future, if updated. METHODS: A survey was developed using several rounds of consultation with a focus group and others. Professional acupuncture membership organisations were contacted to assess their willingness to notify their members. The survey was tested before its launch. RESULTS: Thirty-four professional organisations agreed to participate, together with two research bodies and six UK training institutes. Potentially, around 50 000 professionals practising acupuncture knew about the survey, to which there were 768 responses. Data were analysed for respondent demographics. Around 70% used EA, but <25% used related electrotherapy modalities. Men were more likely than women to use more than one modality. Only around 7% of respondents used non-traditional acupuncture modalities without prior training. However, awareness and usage of the EAK database was low, although around 80% of respondents stated they might use the database in the future, primarily to improve clinical practice. CONCLUSIONS: To the best of our knowledge, this is the largest survey on EA and related modalities ever conducted. As such, its results are likely to be of interest to acupuncture and other practitioners (whether or not they use EA), patients, policymakers, and funding agencies.

Chinese medicine treatment for menopausal symptoms in the UK health service: is a clinical trial warranted?

OBJECTIVES: The aims of this pilot study were to evaluate treatment effects, ascertain safety and formulate best practice Chinese medicine protocols relevant for London women suffering from menopausal symptoms. STUDY DESIGN: This clinical pilot study employed a case series design within a wider action-based research project. 117 perimenopausal women between 45 and 55 years of age recruited from the general population were treated for menopausal symptoms by six experienced practitioners of Chinese medicine at the Polyclinic of the University of Westminster. Practitioners were instructed to treat as near to their usual practice style as possible. This involved using Chinese herbal medicine and/or acupuncture along with dietary and lifestyle advice. A maximum of 12 treatments over 6 months was allowed per patient. OUTCOME MEASURES: The menopause specific quality of life questionnaire (MenQoL), the Greene climacteric scale, and flushing diaries were used to evaluate treatment outcomes. Liver and kidney function tests were carried out at intake and after 1, 6 and 12 treatments to evaluate the safety particularly in relation to the use of herbal medicines. RESULTS: Patients showed significant improvement across all domains measured by the MenQoL and Greene climacteric scales. Reduction on the MenQoL scale between first and last visit was from 4.31 to 3.27 (p<0.001) and on the Green climacteric scale from 21.01 to 13.00 (p<0.001). Study participants did not reliably complete their flushing diaries. No adverse events or abnormal liver or kidney function values were observed during the course of the study. CONCLUSIONS: Further research that seeks to investigate the effects observed in more detail and to evaluate them against other forms of treatment and/or no-treatment controls is warranted. This could be achieved by way of a pragmatic randomized controlled trial that evaluated Chinese medicine against orthodox medical care.

Exploring practice characteristics and research priorities of practitioners of traditional acupuncture in China and the EU-A survey.

ETHNOPHARMACOLOGICAL RELEVANCE: Acupuncture practice is based on the theoretical, historical and philosophical principles, which are part of Chinese medicine. Traditional acupuncture practitioners assess their patients' conditions using Chinese medicine diagnostic techniques, which determine clinical care and treatment. Little is known about differences in the perceptions of research evidence among practitioners in the European Union (EU) and China, given the diversity of acupuncture practice. MATERIAL AND METHODS: This study explored differences between practitioners of traditional acupuncture regarding perceived need for research evidence and prioritisation for future clinical trials, based on their practice within the EU and China. A convenience sample of acupuncturists in the EU (contacted by their professional organisation) and China (from geographically dispersed hospitals) were invited to participate in a survey, which was conducted during 2010/2011. Data collected included: practitioners' demographic details, country of training, practice setting, acupuncture techniques, perceived adverse event reporting, diagnostic methods, conditions commonly treated, conditions perceived as needing more evidence and practitioner perceptions of conditions which could demonstrate benefit if investigated in clinical trials. RESULTS: From 1126 survey responses, 1020 (559 EU, 461 China) could be included in the analysis for direct comparison. A response rate for the EU could not be calculated but for China was 98%. Pain was the most frequently reported commonly treated condition by EU acupuncturists and neurological conditions (mainly stroke) for Chinese practitioners. The top reported priorities for research were obstetrics/gynaecological conditions in the EU and neurological problems in China. CONCLUSION: The survey identified differences in practice and training between acupuncturists in China and the EU and between EU member states. These differences may inform prioritisation of health conditions for future trials. Innovative research methods are recommended to incorporate the complexity and plurality of acupuncture practice and theory. Creation of collaborative networks is crucial in overcoming these differences to facilitate international, multi-centre clinical trials.

A review of Omics research in acupuncture: the relevance and future prospects for understanding the nature of meridians and acupoints.

RELEVANCE: Acupuncture is an intrinsic part of traditional Chinese medicine. The current understanding of the acupuncture meridian system, acupoints and the potential utilizing Omics technologies are summarized in this review. MATERIAL AND METHODS: A systematic search for acupuncture involving Omics technologies was carried out using multiple online literature databases. The records retrieved were from the full collections of each database dated to September 2011. Data produced from functional genomic technologies were extracted from the collected acupuncture/moxibustion studies and subjected to evaluation. Analyses and comments were summarized on the advances in experimental research in acupuncture/moxibustion-related studies, and the future for strategies and approaches in the era of functional genomics highlighted. RESULTS: An overview of articles indicated that several diseases or symptoms with evidence of effectiveness had been piloted for using functional genomic technologies, such as Parkinson's disease, allergic disorders, pain, and spinal cord injury, most of which are chronic "difficult diseases". High-throughput genomic and proteomic profiling of gene expression in tissues has been able to identify potential candidates for the effects of acupuncture and provide valuable information toward understanding the possible mechanisms of the therapy. However, without further holistic and sophisticated analyses in the context of metabolomics and systems biology, the current attempts and the foreseeable developments appear to be insufficient to produce firm conclusions. Noticeably, the recent rapid advances in functional molecular imaging targeting specific metabolites have shown great promise and if combined with other post-genomic technologies, could be extremely helpful for the acupuncture studies in human subjects. CONCLUSION: This review suggest that disease-oriented studies using the approach of multi-indexed high-throughput technologies and systems biology analyses will be a preferred strategy for future acupuncture/moxibustion research.

Extent of acupuncture practice for infertility in the United Kingdom: experiences and perceptions of the practitioners.

OBJECTIVE: To investigate acupuncture practitioners' experience and perceptions of supporting patients presenting with fertility issues. DESIGN: Questionnaire survey. SETTING: British Acupuncture Council. PATIENT(S): British Acupuncture Council acupuncture practitioners. INTERVENTION(S): Questionnaire designed for the study, by post and online. MAIN OUTCOME MEASURE(S): Questions on education and training, size and nature of practice, liaison with conventional care, and perceptions about use of acupuncture for fertility issues. RESULT(S): Questionnaires were sent to 2,580 practitioners. Of 861 responses, 15% of practitioners supporting fertility issues said this constituted a large proportion of their case load. Eighty percent of practitioners reported most fertility work was related to assisted conception. More than 60% had specialist training. Practitioners' perceived benefits included stress reduction, relaxation, regulation of menstrual cycle, and emotional support. Emotional burden on both patients and practitioners was recognized and the limits of therapy. Point-specific acupuncture protocols were common (70%). Thirteen percent reported problems working with physicians. Use of acupuncture for male fertility issues was uncommon. CONCLUSION(S): A minority of acupuncturists have become specialists in supporting fertility issues. The use of an acupuncture protocol is common but does not conform to traditional acupuncture as it is taught and practiced for other conditions.

Engaging in the audit of acupuncture practice.

OBJECTIVES: A pilot study was undertaken to examine the feasibility of auditing and developing a national database of acupuncture practice in the United Kingdom. METHODS: One hundred forty-five (145) practitioners, members of the British Acupuncture Council, were invited to participate in the study. Those who accepted were given training and then asked to record demographic and treatment outcomes data on new patients attending their practices over a 3-month period. Two questionnaires, the Measure Your Own Medical Outcomes Profile and the College of Integrated Chinese Medicine outcome questionnaire, were compared. Baseline health status was assessed and repeated patient feedback questionnaires employed. RESULTS: Of the 31 (21%) of practitioners who responded, only 9 (6%) eventually contributed data. A total of 69 patients participated in the study: 43 (68%) of the patients were female, and 46 (73%) were aged between 30 and 59. More than half (52%) had had their presenting problem for over 5 years and most (78%) were affected daily by it. Nineteen (30%) had had prior acupuncture treatment for their condition. The main categories of complaints reported were musculoskeletal and psychologic. Thirty-two (32) out of 41 (78%) patients with completed final outcomes data recorded moderate or major benefit in their main complaint, with no reports of deterioration. CONCLUSIONS: Although willing to be involved, practitioners found the research process time-consuming and were concerned how it could be balanced against the demands of a busy practice and the interests of patients. For a national audit study to succeed, the process would have to be simplified and practitioners encouraged to engage; collection of such information could then help to provide much-needed data on acupuncture treatment in the United Kingdom.