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Liu W, Qdaisat A, Lopez G, Narayanan S, Underwood S, Spano M, Reddy A, Guo Y, Yeung SC, Bruera E, Cohen L. Association Between Acupoint Selection, Target Symptoms, and Traditional Chinese Medicine Diagnosis in Real-Time Clinical Practice in a Comprehensive Cancer Center. Integr Cancer Ther 2021; 19:1534735420928490. [PMID: 32508209 PMCID: PMC7287401 DOI: 10.1177/1534735420928490] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Acupuncture intervention in actual practice is rarely
reported and may be different from that applied in acupuncture research.
Objectives: To review acupuncture practice in an integrative
medicine clinic and characterize the association between targeted symptoms,
traditional Chinese medicine (TCM) diagnosis, and acupoint selection.
Methods: We reviewed outpatient acupuncture records from March
2016 to April 2018. Statistical analyses were applied to characterize referral
symptoms and associated TCM diagnosis as well as acupoint selection.
Results: The final analysis included 5393 acupuncture records
(1264 patients). Twelve TCM diagnosis components were identified in the referral
symptoms of pain, neuropathy, xerostomia, and hot flashes. Pain was associated
with 78 different TCM diagnoses (combinations of TCM diagnosis components).
Total of 217 different acupoints were used in the acupuncture treatments (1739)
for neuropathy. The acupoint yintang was used in 73.8% of the visits for
neuropathy, yet only in 26.5% (P < .001) of the treatments
when patients had a TCM diagnosis of qi deficiency, qi stagnation, and blood
stagnation. Similarly, both consistencies and variations were seen in acupoint
selection with each targeted symptom and its associated TCM diagnoses.
Conclusions: TCM diagnosis was not homogeneous among
acupuncture treatments for a single referral symptom. In contrast to most of the
research on acupuncture for symptom control, there were considerable variations
in acupoint selection among treatments for the same symptom in a clinical
setting. Future research is needed to examine the clinical relevance of a fixed
intervention structure in acupuncture research and the value of individualized
acupuncture treatment.
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Affiliation(s)
- Wenli Liu
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Aiham Qdaisat
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gabriel Lopez
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Susan Underwood
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael Spano
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Akhila Reddy
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ying Guo
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sai-Ching Yeung
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eduardo Bruera
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lorenzo Cohen
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Lee YS, Ryu Y, Yoon DE, Kim CH, Hong G, Hwang YC, Chae Y. Commonality and Specificity of Acupuncture Point Selections. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2020; 2020:2948292. [PMID: 32802119 PMCID: PMC7403905 DOI: 10.1155/2020/2948292] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 06/17/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Because individual acupoints have a wide variety of indications, it is difficult to accurately identify the associations between acupoints and specific diseases. Thus, the present study aimed at revealing the commonality and specificity of acupoint selections using virtual medical diagnoses based on several cases. METHODS Eighty currently practicing Korean Medicine doctors were asked to prescribe acupoints for virtual acupuncture treatment after being presented with medical information extracted from 10 case reports. The acupoints prescribed for each case were quantified; the data were normalised and compared among the 10 cases using z-scores. A hierarchical cluster analysis was conducted to categorise diseases treated based on the acupoint prescription patterns. Additionally, network analyses were performed on the acupoint prescriptions, at the individual case and cluster level. RESULTS Acupoints ST36, LI4, and LR3 were most commonly prescribed across all diseases. Regarding the specific acupoints prescribed in each cluster, acupoints around the disease site (knee and lower back) were frequently used in cluster A (musculoskeletal symptoms), acupoints LI4, LR3, PC6, and KI3 were frequently used in cluster B (psychiatric symptoms), and acupoints ST36, LI4, LR3, PC6, CV12, and SP6 were frequently used in cluster C (several symptoms of diseases of internal medicine). CONCLUSIONS The present study identified the commonality and specificity of acupoint selections based on virtual acupuncture treatments prescribed by practicing clinicians. Acupoint selection patterns, which were defined using a top-down approach in previous studies and classical medical texts, may be further elucidated using a bottom-up approach based on patient medical records.
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Affiliation(s)
- Ye-Seul Lee
- Department of Anatomy and Acupoint, College of Korean Medicine, Gachon University, Seongnam, Republic of Korea
| | - Yeonhee Ryu
- KM Fundamental Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Da-Eun Yoon
- Acupuncture & Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Cheol-Han Kim
- Acupuncture & Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Geesoo Hong
- Acupuncture & Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Ye-Chae Hwang
- Acupuncture & Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Younbyoung Chae
- Acupuncture & Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
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Jacobson E, Conboy L, Tsering D, Shields M, McKnight P, Wayne PM, Schnyer R. Experimental Studies of Inter-Rater Agreement in Traditional Chinese Medicine: A Systematic Review. J Altern Complement Med 2019; 25:1085-1096. [PMID: 31730402 PMCID: PMC6864748 DOI: 10.1089/acm.2019.0197] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Objectives: It has been recommended that clinical trials of Traditional Chinese Medicine (TCM) would be more ecologically valid if its characteristic mode of diagnostic reasoning were integrated into their design. In that context, however, it is also widely held that demonstrating a high level of agreement on initial TCM diagnoses is necessary for the replicability that the biomedical paradigm requires for the conclusions from such trials. Our aim was to review, summarize, and critique quantitative experimental studies of inter-rater agreement in TCM, and some of their underlying assumptions. Design: Systematic electronic searches were conducted for articles that reported a quantitative measure of inter-rater agreement across a number of rating choices based on examinations of human subjects in person by TCM practitioners, and published in English language peer-reviewed journals. Publications in languages other than English were not included, nor those appearing in other than peer-reviewed journals. Predefined categories of information were extracted from full texts by two investigators working independently. Each article was scored for methodological quality. Outcome measures: Design features across all studies and levels of inter-rater agreement across studies that reported the same type of outcome statistic were compared. Results: Twenty-one articles met inclusion criteria. Fourteen assessed inter-rater agreement on TCM diagnoses, two on diagnostic signs found upon traditional TCM examination, and five on novel rating schemes derived from TCM theory and practice. Raters were students of TCM colleges or graduates of TCM training programs with 3 or more years experience and licensure. Type of outcome statistic varied. Mean rates of pairwise agreement averaged 57% (median 65, range 19-96) across the 9 studies reporting them. Mean Cohen's kappa averaged 0.34 (median 0.34, range 0.07-0.59) across the seven studies reporting them. Meta-analysis was not possible due to variations in study design and outcome statistics. High risks of bias and confounding, and deficits in statistical reporting were common. Conclusions: With a few exceptions, the levels of agreement were low to moderate. Most studies had significant deficits of both methodology and reporting. Results overall suggest a few design features that might contribute to higher levels of agreement. These should be studied further with better experimental controls and more thorough reporting of outcomes. In addition, methods of complex systems analysis should be explored to more adequately model the relationship between clinical outcomes, and the series of diagnoses and treatments that are the norm in actual TCM practice.
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Affiliation(s)
- Eric Jacobson
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA
- Department of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Lisa Conboy
- Department of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
- New England School of Acupuncture, Massachusetts College of Pharmacy and Health Sciences University, Worcestor, MA
| | | | - Monica Shields
- New England School of Acupuncture, Massachusetts College of Pharmacy and Health Sciences University, Worcestor, MA
| | | | - Peter M. Wayne
- Osher Center for Integrative Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Rosa Schnyer
- Department of Adult Health, School of Nursing, University of Texas, Austin, TX
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Alvim DT, Ferreira AS. Pragmatic Combinations of Acupuncture Points for Lateral Epicondylalgia are Unreliable in the Physiotherapy Setting. J Acupunct Meridian Stud 2018; 11:367-374. [PMID: 30092365 DOI: 10.1016/j.jams.2018.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 07/16/2018] [Accepted: 07/30/2018] [Indexed: 01/07/2023] Open
Abstract
This study describes the reliability of pragmatic combinations of acupuncture points for lateral epicondylalgia (LE) as prescribed by physiotherapists who were experts in acupuncture. Raters (n = 14; 33-59 years) independently prescribed acupuncture points for 30 simulated human patients with LE who were surveyed via a printed questionnaire. The frequency and cooccurrence of acupuncture points prescribed for patients with lateral epicondylitis were assessed. Absolute agreement and Light's kappa (κLight) with 95% confidence interval (CI) were used to quantify the interrater agreement. Raters prescribed 103 unique acupuncture points in different combinations with a median (min-max) of 5 (0-11) acupuncture points. The most prescribed acupuncture point was LI-11 (297 of 420; 71%), and the most common cooccurring acupuncture points were LI-11 and LI-4 (160 of 420; 38%). The absolute agreement for prescribing the acupuncture points ranged from 70% (point GB-20) to 0% (points LI-10, SP-6, LI-11, GB-34, LI-12, and LI-4). Point LR-3 showed the highest interrater reliability for prescribing the acupuncture points [κLight = 0.112, 95% CI = (0.055-0.194)], whereas point LI-4 showed the lowest reliability [κLight = -0.003, 95% CI = (-0.024 to 0.024)]. These findings suggest that pragmatic prescriptions of acupuncture points for LE are unreliable among physiotherapists who are experts in acupuncture. Explicit, high-level evidence-based rules for prescribing and teaching combinations of acupuncture points for LE are warranted.
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Affiliation(s)
- Danielle T Alvim
- Laboratory of Computational Simulation and Modeling in Rehabilitation, Postgraduate Program in Rehabilitation Sciences, Augusto Motta University Center, Praça das Nações, 34, Bonsucesso, Rio de Janeiro, RJ, 21041-010, Brazil; Research Laboratory of Exercise Sciences, Physical Education Center Admiral Adalberto Nunes, Brazilian Navy, Av. Brasil, 10590, Penha, Rio de Janeiro, RJ, 21012-350, Brazil
| | - Arthur S Ferreira
- Laboratory of Computational Simulation and Modeling in Rehabilitation, Postgraduate Program in Rehabilitation Sciences, Augusto Motta University Center, Praça das Nações, 34, Bonsucesso, Rio de Janeiro, RJ, 21041-010, Brazil; Salgado de Oliveira University, Rua Marechal Deodoro 263, Centro, Niterói, RJ, 24030-060, Brazil.
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Traditional Chinese Medicine for Sexual Dysfunction: Review of the Evidence. Sex Med Rev 2018; 6:410-418. [PMID: 29371144 DOI: 10.1016/j.sxmr.2017.11.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 11/17/2017] [Accepted: 11/26/2017] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Despite the growing popularity of traditional Chinese medicine (TCM) in the Western world, biomedical students and practitioners struggle to understand TCM and how it relates to their standard diagnosis and treatment practices. AIMS To describe the fundamentals of TCM theory and practice relevant to sexual dysfunction; to review and critique the current state of TCM research within Western biomedical literature; and to identify sites for improvement of future research and for collaborative integration of TCM and biomedicine in practice. METHODS Information about TCM from an insider perspective was obtained from English-language textbooks and lectures intended to teach Western students its theory and practice. PubMed search using Medical Subject Heading terms for Western sexual diagnoses and TCM treatments was performed in April and October 2017 to represent the evidence for TCM in Western biomedical literature. Articles in non-English languages and without human subjects were excluded. MAIN OUTCOME MEASURES 27 studies were included in this review. The most commonly studied intervention was acupuncture. An equal number of studies addressed sexual dysfunction in men and women, but only women were included in studies of physically passive mindfulness meditation. RESULTS Compared with Western biomedicine, TCM offers a more interdisciplinary and individualized approach to disease and its treatment. This embrace of individual idiosyncrasy in diagnosis and treatment presents a challenge to Western biomedical research norms that rely almost exclusively on quantitative methods that compare large and homogeneous groups with a fixed diagnosis and treatment regimen. CONCLUSION TCM offers a very different understanding of the human body, health, and disease from Western biomedicine. There is value in the study and application of these 2 medical systems, particularly for biopsychosocial problems of sexual dysfunction. However, this must be done cautiously, with attention to appropriate study design, to avoid shallow and unscientific cultural appropriation of TCM practices. Chubak B, Doctor A. Traditional Chinese Medicine for Sexual Dysfunction: Review of the Evidence. Sex Med Rev 2018;6:410-418.
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Effects of diagnostic errors in pattern differentiation and acupuncture prescription: a single-blinded, interrater agreement study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 2015:469675. [PMID: 25945109 PMCID: PMC4405219 DOI: 10.1155/2015/469675] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 03/14/2015] [Accepted: 03/15/2015] [Indexed: 11/17/2022]
Abstract
This study compared the interrater agreement for pattern differentiation and acupoints prescription between two groups of human patients simulated with different diagnostic outcomes. Patients were simulated using a dataset about zangfu patterns and separated into groups (n = 30 each) according to the diagnostic outcome determined by a computational model. A questionnaire with 90 patients was delivered to 6 TCM experts (4-year minimal of clinic experience) who were asked to indicate a single pattern (among 73) and 8 acupoints (among 378). Interrater agreement was higher for pattern differentiation than for acupuncture prescription. Interrater agreement on pattern differentiation was slight for both groups with correct (Light's κ = 0.167, 95% CI = [0.108; 0.254]) and incorrect diagnosis (Light's κ = 0.190, 95% CI = [0.120; 0.286]). Interrater agreement on acupuncture prescription was slight for both groups of correct (ι = 0.029, 95% CI = [0.015; 0.057]) and incorrect diagnosis (ι = 0.040, 95% CI = [0.023; 0.058], P = 0.075). Diagnostic performance of raters yielded the following: accuracy = 60.9%, sensitivity = 21.7%, and specificity = 100%. An overall improvement in the interrater agreement and diagnostic accuracy was observed when the data were analyzed using the internal systems instead of the pattern's labels.
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