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主题：【原创】看看针灸的临床研究结果 -- 虽远必诛
家园 【原创】看看针灸的临床研究结果 不是总有人说疗效说话吗？
看看针灸研究的临床结果。
1 针灸对腰痛
Cochrane reivew外链出处
Authors' conclusions
The data do not allow firm conclusions about the effectiveness of acupuncture for acute low-back pain. For chronic low-back pain, acupuncture is more effective for pain relief and functional improvement than no treatment or sham treatment immediately after treatment and in the short-term only. Acupuncture is not more effective than other conventional and "alternative" treatments. The data suggest that acupuncture and dry-needling may be useful adjuncts to other therapies for chronic low-back pain. Because most of the studies were of lower methodological quality, there certainly is a further need for higher quality trials in this area.
Meta-Analysis: Acupuncture for Low Back Pain
Eric Manheimer, MS; Adrian White, MD, BM, BCh; Brian Berman, MD; Kelly Forys, MA; and Edzard Ernst, MD, PhD外链出处
Current data show that acupuncture is more effectivethan sham acupuncture and no additional treatment for
providing short-term relief of chronic low back pain. This
short-term relief seems to be sustained over the longer
term;
^ Chou R, Huffman LH (2007). "Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline". Ann Intern Med. 147 (7): 492–504. doi:10.1001/archinte.147.3.492. PMID 17909210.外链出处
We found fair evidence that acupuncture, massage, yoga (Viniyoga), and functional restoration are also effective for chronic low back pain.这个几个系统回顾已经非常清楚了，针灸对慢性腰痛有一些效果，但是持续时间比较短。对急性腰痛效果不佳。
因此不要在用个例来说明针灸治愈腰痛了。
同时这段解释也确实说明国内科研的现状
Our search for eligible reports was nearly comprehensive,resulting in the identification of 33 RCTs—more
than twice as many as included in any previous review on
this topic. Because of resource limitations, we did not
search Chinese databases. This may have deflated our estimates
of effects because acupuncture RCTs published in
China have been shown to be positive in 100% of all cases
(60). The comprehensiveness of our searches (with the exception
of Chinese databases) might be expected to limit
the effects of publication bias.
2，针灸对术后恶心呕吐：
Stimulation of the wrist acupuncture point P6 for preventing postoperative nausea and vomiting外链出处
有效，但是不必止吐药好。
3，针灸对In vitro fertilisation试管婴儿
Conclusion Currently available literature does not provide sufficient evidence that adjuvant acupuncture improves IVF clinical pregnancy rate.4，针灸对颈痛
Acupuncture for neck disorders外链出处
Authors' conclusions
There is moderate evidence that acupuncture relieves pain better than some sham treatments, measured at the end of the treatment. There is moderate evidence that those who received acupuncture reported less pain at short term follow-up than those on a waiting list. There is also moderate evidence that acupuncture is more effective than inactive treatments for relieving pain post-treatment and this is maintained at short-term follow-up.
短期有效。
5，头痛，
偏头痛有效，但是同针灸部位无关，随便扎。
6， OA，有效，短期症状控制，无法治愈。
因此这些证据非常清楚，不论机理如何，(对机理的研究也很多)从临床实践角度看。
如果您有慢性腰痛，颈痛，头痛，OA（老寒腿）之类的，可以用针灸治疗，但是不要指望去根。
如果是急性腰痛，颈痛可能用针灸没有多大用处。
另外有明确的证据证明针灸对一下疾病无效：哮喘，面瘫，抑郁，月经失调，癫痫，青光眼，失眠，类风湿关节炎，肩痛，精神分裂，纤维肌痛，戒烟，急性中风，中风康复，网球肘，老年痴呆等。
所以，在说针灸治好了，谁谁谁知前，先看看专业研究的结果。
现在看看这个回顾的结果，可能更加说明问题。
Acupuncture treatment for pain: systematic review of randomised clinical trials with acupuncture, placebo acupuncture, and no acupuncture groups外链出处
结果竟然是：
ConclusionWe found a small analgesic effect of acupuncture that seems to lack clinical relevance and cannot be clearly distinguished from bias. Whether needling at acupuncture points, or at any site, reduces pain independently of the psychological impact of the treatment ritual is unclear.
轻微的镇痛效果，但是同扎针的部位没有关系----穴位不重要。同安慰剂没区别，同不扎针没区别。
还有随着研究的深入，不是像这里的某些人认为的，对针灸的研究一直非常活跃，实验设计的完善，高质量的试验，反而证明针灸同安慰剂间差距越来越小。 Singh, S; Ernst E (2008). Trick or treatment: The undeniable facts about alternative medicine. W. W. Norton & Company. ISBN 0393066616.
总结一下，针灸，我天天用，但是我不会对我的患者说，针灸会去根。
针灸很明确就是一个镇痛的手段，短时间用，效果有，副作用小。虽然不方便，成本大，但是还是有很多患者接受。
如果对OA的患者说：把您放倒，扎上，就此腿就不瘸了。
那是某些人追求的大师，大仙，在现实生活中不存在的。
客观一点，对中医，对患者都有好处。
最后，您的期望值，您兜里的银子都要小心，大仙的嘴，大神的手。
通宝推：一觉到天亮,
本帖一共被 1 帖 引用 (帖内工具实现)家园 用外国人的研究说明中医的效果 不靠谱。真的不靠谱。
至于中国人的研究，同样不靠谱。
所以，还是存而不论吧。过几十年，等中国人恢复了自信心和平常心再说吧。那时，也许才是对中医乃至所有传统文化做出评价的时候。
家园 虽远大夫您的英语可真好 在下不是医疗相关专业的，斗胆把您的引文翻译一下。
1 针灸对腰痛Cochrane reivew链接出处
Authors' conclusions
The data do not allow firm conclusions about the effectiveness of acupuncture for acute low-back pain. For chronic low-back pain, acupuncture is more effective for pain relief and functional improvement than no treatment or sham treatment immediately after treatment and in the short-term only. Acupuncture is not more effective than other conventional and "alternative" treatments. The data suggest that acupuncture and dry-needling may be useful adjuncts to other therapies for chronic low-back pain. Because most of the studies were of lower methodological quality, there certainly is a further need for higher quality trials in this area.
作者的结论（这是一篇综述）：
这篇文章里的数据并不能给出确切的结论来支持针灸对于腰痛的治疗作用。对于慢性腰痛来说，针灸相对于不治疗或者安慰治疗（或者欺骗治疗），在治疗后立即具有镇痛效果，但是只有短期效果。针灸相对于其他的传统疗法或者替代疗法，并不具有更优越的疗效。这里的数据指出，针灸以及干针可能可以被用作治疗慢性腰痛的辅助手段。但是因为本文提及的这些研究的方法学质量很低，在这个领域仍然需要进行更高质量的实验
Meta-Analysis: Acupuncture for Low Back PainEric Manheimer, MS; Adrian White, MD, BM, BCh; Brian Berman, MD; Kelly Forys, MA; and Edzard Ernst, MD, PhD链接出处
Current data show that acupuncture is more effective
than sham acupuncture and no additional treatment for
providing short-term relief of chronic low back pain. This
short-term relief seems to be sustained over the longer
term;
现有的数据表明，针灸相对于安慰治疗以及无附加治疗（估计就是只用其他治疗手段），对慢性腰痛有更好镇痛效果。有迹象表明（或者看起来）这种短期镇痛效果能够延续长期延续
^ Chou R, Huffman LH (2007). "Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline". Ann Intern Med. 147 (7): 492–504. doi:10.1001/archinte.147.3.492. PMID 17909210.链接出处We found fair evidence that acupuncture, massage, yoga (Viniyoga), and functional restoration are also effective for chronic low back pain.
我们指出了很一般（不知道fair具体咋翻，大概就是不大好的感觉）证据来支持针灸、按摩、瑜伽、以及功能恢复疗法等对于慢性腰痛的疗效
先翻译这些，等下接着来
家园 累了，回头再接着翻译吧 家园 接上文翻译 同时这段解释也确实说明国内科研的现状Our search for eligible reports was nearly comprehensive,
resulting in the identification of 33 RCTs—more
than twice as many as included in any previous review on
this topic. Because of resource limitations, we did not
search Chinese databases. This may have deflated our estimates
of effects because acupuncture RCTs published in
China have been shown to be positive in 100% of all cases
(60). The comprehensiveness of our searches (with the exception
of Chinese databases) might be expected to limit
the effects of publication bias.
我们对于符合条件的文献的搜索近乎全面，得到了33个确定的RCT--几乎是以前这个领域的综述的两倍。由于资源限制，我们并没有搜索中文数据库。这个可能会缩小（或减弱）我们对于针灸RCT的效果判断，因为在中文期刊中发表的有关针灸的RCT中，正面效果在所有的60篇文章中都是100%。 我们全面的搜索（出去中文数据库外）或许可以消除出版物的倾向带来的误导效果。
2，针灸对术后恶心呕吐：
Stimulation of the wrist acupuncture point P6 for preventing postoperative nausea and vomiting链接出处
有效，但是不必止吐药好。
我专门去看了原文的摘要，现转贴如下
Background
Postoperative nausea and vomiting (PONV) are common complications following surgery and anaesthesia. Drugs to prevent PONV are only partially effective. An alternative approach is to stimulate the P6 acupoint on the wrist. This is an update of a Cochrane review first published in 2004.
Objectives
To determine the efficacy and safety of P6 acupoint stimulation in preventing PONV.
Search strategy
We searched CENTRAL (The Cochrane Library, Issue 3, 2008), MEDLINE (January 1966 to September 2008), EMBASE (January 1988 to September 2008), ISI Web of Science (January 1965 to September 2008), the National Library of Medicine publication list of acupuncture studies, and reference lists of articles.
Selection criteria
All randomized trials of techniques that stimulated the P6 acupoint compared with sham treatment or drug therapy for the prevention of PONV. Interventions used in these trials included acupuncture, electro-acupuncture, transcutaneous nerve stimulation, laser stimulation, capsicum plaster, an acu-stimulation device, and acupressure in patients undergoing surgery. Primary outcomes were the risks of nausea and vomiting. Secondary outcomes were the need for rescue antiemetic therapy and adverse effects.
Data collection and analysis
Two review authors independently assessed trial quality and extracted the data. We collected adverse effect information from the trials. We used a random-effects model and reported relative risk (RR) with associated 95% confidence intervals (95% CI).
Main results
We included 40 trials involving 4858 participants; four trials reported adequate allocation concealment. Twelve trials did not report all outcomes. Compared with sham treatment P6 acupoint stimulation significantly reduced: nausea (RR 0.71, 95% CI 0.61 to 0.83); vomiting (RR 0.70, 95% CI 0.59 to 0.83), and the need for rescue antiemetics (RR 0.69, 95% CI 0.57 to 0.83). Heterogeneity among trials was moderate. There was no clear difference in the effectiveness of P6 acupoint stimulation for adults and children; or for invasive and noninvasive acupoint stimulation. There was no evidence of difference between P6 acupoint stimulation and antiemetic drugs in the risk of nausea (RR 0.82, 95% CI 0.60 to 1.13), vomiting (RR 1.01, 95% CI 0.77 to 1.31), or the need for rescue antiemetics (RR 0.82, 95% CI 0.59 to 1.13). The side effects associated with P6 acupoint stimulation were minor. There was no evidence of publication bias from contour-enhanced funnel plots.
Authors' conclusions
P6 acupoint stimulation prevented PONV. There was no reliable evidence for differences in risks of postoperative nausea or vomiting after P6 acupoint stimulation compared to antiemetic drugs.
我的翻译如下：
背景：
术后恶心以及呕吐（PONV）在外科手术以及麻醉后是常见的复杂因素（或者症状？）药物预防PONV只是部分有效。一种替代疗法是刺激位于手腕上的P6穴位。这篇综述是对于2004年发表在Cochrane上的第一综述的更新。
目标：
判段 P6穴道刺激预防PONV的效果以及安全性。
搜索策略
我们搜索了CENTRAL (The Cochrane Library, Issue 3, 2008), MEDLINE (January 1966 to September 2008), EMBASE (January 1988 to September 2008), ISI Web of Science (January 1965 to September 2008), 国家图书馆药物刊物部分关于针灸的研究，以及这些文章的引文列表。
数据采集和分析
所有的有关于刺激P6穴位相对于安慰疗法或者药物治疗预防PONV的实验技术被随机排列。在这些实验中使用的介入方法包括针灸，电针灸，经皮（皮下或者透皮？）神经刺激，激光刺激，辣椒涂覆，一个穴位刺激仪器，对手术中的患者进行穴位按压。主要的结果是恶心以及呕吐的风险。第二个结果是对于紧急止吐疗法的需求以及反效果。
两位综述作者独立的评估了实验的质量并且收集了数据。我们从这些实验中收集了反作用的数据。我们使用了随机效应模型并且报道了相对风险RR为95%的置信区间（95%CI)
主要的结果
这篇文章包含了40个实验共4858个参与者。其中4个实验报道了适当分配隐藏，12个实验并没有报道所有的结果。与安慰疗法相比，P6穴位刺激明显的减轻了恶心（RR 0.71 95% CI 0.61到0.83) 呕吐(RR 0.70, 95% CI 0.59 to 0.83)，以及对于紧急止吐疗法的需求(RR 0.69, 95% CI 0.57 to 0.83)。不同实验之间的异质性非常温和（波动很小）。对于成人以及儿童进行的P6穴位刺激和安慰疗法对比并没有明显的差别。或者对于侵入性以及非侵入性穴位刺激也没有明显区别。并没有证据能够区分P6穴位刺激以及止吐药对于恶心 (RR 0.82, 95% CI 0.60 to 1.13), 呕吐 (RR 1.01, 95% CI 0.77 to 1.31)的效果，或者对于紧急制图要的需求 (RR 0.82, 95% CI 0.59 to 1.13)。 与P6穴位刺激相关的副作用非常小。没有证据表明有由轮廓增强的漏斗图导致的刊物倾向。
作者的结论：
P6穴位刺激能够预防术后恶心以及呕吐。迄今为止并没有可信的证据表明P6穴位刺激与止吐药相比，用于治疗术后恶心和呕吐时有风险区别。
家园 大夫好！ 其实，现在的国内医疗大环境，当群众哪里不舒服的时候，先看的都是西医。当西医无能为力、没有效果的时候，群众再退而求其次地去寻去其他途径，目的是为了缓解痛苦。至于费用，其实，西医的各种名目的检查费、药费，那也是相当地不菲的，针灸扎一次几十元（好像还要便宜些），即使能暂缓一下痛苦，也不算贵了--好像也在医保范围内。
针灸俺自己是没接触过，因为身体素质太好之故呵呵！但举一个反例，唱个反调哈，针灸治疗失眠是有效的。前阵子我一个同学严重失眠近十天（由于其自身也是医生，所以拒绝吃安眠药之类的）、后俺实在看不过去、在心理疏导无效（俺不会催眠术呵呵）的情况下、给联系了一中医朋友，人家用家传的针灸手法给扎了两下，当夜就见效了，现在每天都能睡着几个小时了。
家园 zt 美科学家找到针灸缓解疼痛原因 安慰剂啊安慰剂
美科学家找到针灸缓解疼痛原因
（2010-06-01）
（巴黎法新电）美国神经科学家最近发现，针灸之所以能够缓解肢体疼痛，是因为它能帮助人体释放出腺苷分子的缘故。研究人员发表在《自然—神经学》杂志上的报告说，他们发现，在针灸期间和过后，针灸部位周围组织的腺苷（adenosine)水平突增了24倍，通过测量老鼠对碰触和热的反应时间，可以看出它们的不舒服程度减少了三分之二。他们还用经过基因改造后缺乏腺苷的老鼠作了同样的试验，结果针灸没有任何的效果，老鼠针灸后仍旧像从前一样不舒服。科学家又为老鼠注射了一种治疗白血病的药物脱氧肋间型霉素（Deoxycoformycin），这种药具有阻止生理组织排出腺苷的作用。
结果发现，因为腺苷聚积在这些老鼠体内，它们针灸效果的持续时间几乎延长了两倍。
这项研究的负责人、罗彻斯特大学医学中心的内德高说：“在世界一些地方，针灸作为主要治疗手段已经有四千多年了。但是因为不完全了解作用机理，很多人仍旧怀疑它的作用。”在中枢神经方面，针灸能促使身体发出信号、让大脑产生镇痛的化学物质内腓呔（endorphins）。家园 我妈妈有偏头痛,各种办法都治过,没法治愈. 这几天就在针灸,她说感觉好很多.
不过不知道有没有长期疗效.
家园 有道是，有病乱乱投医