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 2002 2001 Posizione

1) 373 Parto vaginale senza diagnosi complicanti 321.698 322.962 1)

2) 127 Insufficienza cardiaca e shock 186.291 177.276 3)

3) 039 Interventi sul cristallino con o senza

vitrectomia 173.085 229.316 2)

4) 371 Parto cesareo senza complicazioni 156.906 160.440 5)

5) 183 Esofagite, gastroenterite e misc. mal.app.

dig. età >17 anni senza CC 130.570 176.610 4)

6) 410 Chemioterapia non associata a diagnosi

secondaria di leucemia acuta 122.785 129.938 6)

7) 014 Mal. cerebrovascolari specifiche eccetto

attacco ischemico transitorio 119.158 118.730 8)

8) 359 Interventi su utero e annessi non per

neoplasie maligne, senza CC 111.453 116.911 9)

9) 088 Malattia polmonare cronica ostruttiva 111.363 112.739 11)

10) 222 Interventi sul ginocchio senza CC 110.314 113.958 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 meta-analisi.

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 or Free

Access Information

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. 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.

Free Public web access

Embase

Produced by Elsevier Science BV, The Netherlands, Embase has extensive coverage of pharmacological as well as biomedical research. Embase.com allows online searching of the

Emabase database along with selected MEDLINE records.

Fee Subscription based online access

ISI Web of Science - now Thomson Scientific Fee 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)

Database Fee or Free

Access Information

AMED (Allied and Complementary Medicine Database)

Produced by the British Library Health Care Info. Service, this database contains primarily European references, much of which is not found in MEDLINE or EMBASE.

Fee

CD, Online library services, or individual subscription. Search 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

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.

Free Public web access

Cochrane Collaboration, Complementary Field

This international alliance of researchers maintains and updates a registry of randomized controlled trials. The Complementary Medicine Field is based at the University of Maryland. See the Abstracts of systematic reviews related to complementary and alternative medicine.

Free

Abstracts and new

protocols available as pdf file on the CMP website

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.

Free Public web access

DATADIWAN The German, Patienteninformation fur Naturheilkunde, (Patient information for natural therapies) has a searchable database on line, much of it in English, providing information on holistic medicine and a network linking research institutions and organizations worldwide. There are over 6,000 bibliographic entries and 6,000 addresses.

Free Publicly available on DATADIWAN website

[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 Free

Access Information

AGRICOLA AGRICultural OnLine Access is a bibliographic database created by the National Agriculatural Library, USA, and contains citations on

Free Public web access

medicinal plants.

CABI - CAB ABSTRACTS Bibliographic database from UK, covers agriculture, forestry, aspects of human health, nutrition, and management and conservation of natural resources.

Fee Print and electronic access

CINAHL Cumulative Index to Nursing and Allied Health covers primarily nursing journals and includes CAM citations.

Fee Access through Ovid library service

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.

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.

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.

Free Public web access

PsycINFO Psychological abstracts from 1800s to present includes mind-body and other CAM information.

Fee Online search service for individuals or institutions

[Back to list]

4. Traditional Systems of Medicine Databases

Database Fee or Free

Access Information

African Health Anthology

A bibliographic reference resource that incorporates several Indigenous African medicine Databases

Fee CD-Rom format

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

Free Web search interface

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.

Free Web search interface

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.

Fee No public access. Searches may be requested

JICST-EPlus

Comprehensive bibliographic database with English citations and abstracts, covering Japanese literature on science, technology, and medicine from 1985

Fee Subscription access information on Web site

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.

Fee Web or CD

TEK*PAD Traditional Ecological Knowledge*Prior Arts Database is an index and search engine

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 Fee or Free

Access Information

ACUBASE An acupuncture and TCM practice management tool and a modifiable reference library.

Fee CD format for PC and Mac

Acubriefs Searchable database with over 16,000 citations, many with online links to citation or text, partly sponsored by the Medical Acupuncture Research Foundation

Free Web search interface

EthnobotDb

EthnobotDb is one of Dr. Duke's Phytochemical and Ethnobotanical Databases on the US Agricultural Research Database covering ethnobotanical uses for plants.

Free Web search interface

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.

Free Browsable and searchable on the web

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.

Free and fee

Free web searching and fee based services

IBIDS

The database, International Bibliographic Information on Dietary Supplements, from the Office of Dietary Supplements, NIH, covers vitamins, minerals, and herbs.

Free Searchable on the web

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.

Fee Individual subscription access via Web.

Qi Gong Database 2050 citations from varied sources on clinical and experimental research on Qigong.

Fee CD format for PC and Mac

Treuherz Collection The private homeopathy reference library of Francis Treuherz holds 6,000 volumes. Inquiries can be made through the Society of Homeopaths.

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.

Database Fee or Free

Access Information

AIDSinfo

AIDSinfo is a central resource for federally and privately funded clinical trials for AIDS patients and others infected with HIV.

Free Browsable and searchable on the web

Bandolier Plain English summaries, from UK group, of evidence-based medicine published research presented as searchable documents to provide advice about particular treatments or diseases for healthcare professionals and consumers.

Free Web search interface and downloadable documents

CenterWatch A searchable listing of over 4,100 industry and government-sponsored ongoing clinical trials categorized by therapeutic area and geographic region; useful patient resource

Free Browsable and searchable on the web

ClinicalTrials.gov Provides regularly updated information about federally and privately supported clinical research using human volunteers.

Free Browsable and searchable on the web

Cochrane Library

The Cochrane Library consists of a collection of evidence-based medicine databases, including The Cochrane Database of Systematic Reviews - updated quarterly. Abstracts are freely publicly search and browsable.

Fee Available as Web subscription or CD

CRISP

This searchable database of NIH funded research and intramural research projects contains mainly conventional biomedicine, but contains a growing proportion of alternative medicine research pro jects and clinical trials.

Free Web search interface

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.

Free Web search interface

NCCAM Sponsored Research This listing by year is not in database format but provides an overview of all extramural research sponsored by the National Center for Complementary Medicine

Free Browsable listing

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.

Free Web search interface

[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. rcarmonas1@prodigy.net.mx

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 a4 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)

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 latero-

vertebrale.

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

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. 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. Display Options

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

(Isolagen TherapyTM); 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

(Isolagen TherapyTM); 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 Not yet

recruiting

Traumeel for Post-Tonsillectomy Pain

Condition: Post-Tonsillectomy Interventions: Drug: Traumeel S; Drug: TRAUMEEL S;

Drug: Placebo

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: Sham-

laser 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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Contact Help Desk 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 Intervention Phase

Cancer Procedure: Auricular acupuncture Procedure: Sham auricular acupuncture

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

Procedure: Auricular acupuncture 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).

Procedure: Sham auricular acupuncture

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).

Procedure: Auricular acupuncture 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.

Procedure: Sham auricular acupuncture

C: No Intervention No treatment received.

Show Detailed Description

Eligibility

Ages Eligible for Study: 18 Years and older

Genders Eligible for Study: Both

Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

Histologically or cytologically confirmed carcinoma Patients must have normal organ and marrow function as defined below:

o ANC greater than or equal to 1500/mcL

o Platelets greater than or equal to 100,000/mcL

o 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

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 chihyang@ntu.edu.tw

Contact: Ching-Hung Lin, M.D. 886-2-23123456 ext 7573 chldtmed004@yahoo.com.tw

Locations

Taiwan

Department of Oncology, National Taiwan University Hospital Recruiting Taipei, Taiwan, 100

Contact: Chih-Hsin Yang, PhD 886-2-23123456 ext 7511

chldtmed004@yahoo.com.tw

Contact: Ching-Hung Lin, M.D. 886-2-23123456 ext 7573

chldtmed004@yahoo.com.tw

Principal Investigator: Chih-Hsin Yang, PhD

Sponsors and Collaborators National Taiwan University Hospital Investigators

Principal

Investigator:

Chih-Hsin Yang,

PhD

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

The Journal of Alternative and Complementary Medicine

A Review on the Complementary Effects of Auriculotherapy in Managing

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

Tze-Fan D. Lee, R.N., Ph.D.,2 and

Kwai-Ping L. Suen, R.N., Ph.D.2

1School of Science and Technology, The Open University of Hong Kong, Hong Kong, China.

2The 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.

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 - indexed for MEDLINE]

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]

[Article in Chinese]

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.

PMID: 19157139 [PubMed - indexed for MEDLINE]

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.

alireza.mehdizadeh@gmail.com

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. E-

cshang@caregroup.harvard.edu.

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]

[Article in Chinese]

Liu J, Liang-duo J, Zhao JP.

Department of Internal Medicine, Dongzhimen Hospital, Beijing University of TCM, Beijing 100700, China.

juanjuan000@sina.com

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.

PMID: 17645256 [PubMed - indexed for MEDLINE]

[Study on effects of low frequency pulse plus auricular point magnetic therapy on electrogastrogram and clinical therapeutic effect in the patient of functional dyspepsia]

[Article in Chinese]

Wang YG, Yao SK.

Department of Digestion, The Affiliated Hospital of TCM, Hebei Medical University, Shijiazhuang 050011, China.

wangygang@yahoo.com.cn

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.

PMID: 17585664 [PubMed - indexed for MEDLINE]

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.

PMID: 17054239 [PubMed - indexed for MEDLINE]

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. t_oleson@pacbell.net

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.

PMID: 12016347 [PubMed - indexed for MEDLINE]

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.

PMID: 12082836 [PubMed - indexed for MEDLINE]

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.

PMID: 10516975 [PubMed - indexed for MEDLINE]

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.

PMID: 9229932 [PubMed - indexed for MEDLINE]

[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.

PMID: 7571484 [PubMed - indexed for MEDLINE]

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.

PMID: 7906478 [PubMed - indexed for MEDLINE]

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.

PMID: 8412288 [PubMed - indexed for MEDLINE]

MeSH Terms

LinkOut - more resources[The effect of stimulating the auricular liver-gall

point on the size of gallbladder of the rabbit]

[Article in Chinese]

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.

PMID: 8082285 [PubMed - indexed for MEDLINE]

[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.

PMID: 1481513 [PubMed - indexed for MEDLINE]

[A study on the effect of stimulating auricular points on the biliary tract]

[Article in Chinese]

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.

PMID: 1394955 [PubMed - indexed for MEDLINE]

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

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. 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.

PMID: 1978507 [PubMed - indexed for MEDLINE]

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.

PMID: 3485421 [PubMed - indexed for MEDLINE]

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.

PMID: 3927566 [PubMed - indexed for MEDLINE]

Publication Types, MeSH Terms

Results: 721 to 735 of 735

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text a riviste siti web e altre risorse web.

Ricerche di esempio

The Journal of Alternative and Complementary Medicine

A Review on the Complementary Effects of Auriculotherapy in Managing

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.

Detezione:Elettrica e Baroestesica.

Punto retto (ano,P. emorroidario) funzionale bilaterale per patologie del retto ,stipsi ed emorroidi.

Detezione :Elettrica e Baroestesica.

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.

Detezione :Elettrica e Baroestesica.

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.

Detezione:Elettrica e Baroestesica.

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.