和尚庙

PUBMED上的一些搜索结果，很有趣：

1． 以“acupuncture”为关键词，得到论文13628篇，综述1524篇
2． 以“acupuncture random control”为关键词，得到论文148篇，综述11篇

因为没专业能力也没时间详细读全文，仅读“acupuncture random control”综述摘要部分，当然，是带着我的“偏见”去读的，有些结果挺有趣，*后面是我自己的感想，其他部分是我的翻译：

1． Cochrane Database Syst Rev. 2009 Jan 21;(1):CD001218.，Acupuncture for migraine prophylaxis.
“Pooled analyses did not show a statistically significant superiority for true acupuncture for any outcome in any of the time windows, but the results of single trials varied considerably.”
集中的分析未发现真针灸在任何时间窗口上显示出统计学上显著的优越性，但是单一实验中的结果却千差万别。
“In the previous version of this review, evidence in support of acupuncture for migraine prophylaxis was considered promising but insufficient. Now, with 12 additional trials, there is consistent evidence that acupuncture provides additional benefit to treatment of acute migraine attacks only or to routine care. There is no evidence for an effect of ‘true’ acupuncture over sham interventions, though this is difficult to interpret, as exact point location could be of limited importance.”
上一版的综述中，支持针灸对周期性偏头痛有效的证据被认为有一定的潜力但是证据不充分。现在，随着另外12个实验的加入，有一致的证据表明相对于急性偏头痛或者常规疗法，针灸可带来更多的益处。但是没有证据表明“真”针灸相对于假针灸更有效果，这点很难解释，这表明精确的穴位点没有什么重要的作用。
Available studies suggest that acupuncture is at least as effective as, or possibly more effective than, prophylactic drug treatment, and has fewer adverse effects. Acupuncture should be considered a treatment option for patients willing to undergo this treatment.
目前所能获得的研究数据表明，针灸的效果至少能与药物预防效果相当，或者可能在减少副作用方面更好一些。针灸对于那些愿意接受这种治疗的患者而言应当是选择之一。

*“但是没有证据表明“真”针灸相对于假针灸更有效果，这点很难解释，这表明精确的穴位点没有什么重要的作用”——–这提示通过体表的物理刺激可能确实存在某种未知的镇痛机理，但是跟其理论基础—–经络和阴阳五行—无关。所以，应当进一步研究和明确其机理，将之发展成有现代科学知识为依据的方法，而不是盲目的借此鼓吹“替代疗法有效”。

2. Complement Ther Med. 2008 Apr;16(2):92-100. Epub 2008 Mar 4. Acupuncture for obesity: a systematic review and meta-analysis.
However, the amount of evidence is not fully convincing because of the poor methodological quality of trials reviewed. In conclusion, there is an urgent need for well-planned, long-term studies to address the effectiveness of acupuncture for treating
（数据分析表明针灸对减肥有效），但是，证据的数量并不完全令人信服，因为这些实验在方法学上质量很差。总之，迫切地需要有长期的，设计良好的研究来证明针灸治疗真的有效。
*这还是针对那些有随机对照组的实验的结论：“方法学上质量很差。”，那些连随机对照都没有的呢？？

3． Spine. 2008 Apr 15;33(8):914-8.，The use of expertise-based randomized controlled trials to assess spinal manipulation and acupuncture for low back pain: a systematic review.
Investigators designing acupuncture or spinal manipulation trials in which 2 or more active therapies are compared should consider expertise-based randomization to increase the validity and feasibility of their efforts.
在那些有两个或更多的疗法进行比较的针灸或脊柱疗法的研究中，研究者应当认识到由专家进行的随机分组会增加其对自己主张的疗法的有效性或便利性的评价。
*针灸即便是随机对照，但由于必须由人操作，实际上是“单盲”，因此所谓的“有效”也就很可疑。

4． Zhen Ci Yan Jiu. 2007 Feb;32(1):68-70.，Evaluation and analysis on the methodology of clinical trials of acupuncture treatment of dysphagia due to ischemic stroke
and thus, the rationality and reliability of conclusions about the therapeutic effects of acupuncture for apoplectic dysphagia in many articles are limited. In order to further confirm the effectiveness of acupuncture for dysphagia resulting from ischemic stroke and to provide enough and reliable clinical evidence, it is necessary to adopt the principles and methods of evidence-based medicine to improve our clinical trials and particularly to look for the best model favoring the development of acu-moxibustion study in the coming days.
（通过分析近十年来所有用针灸治疗缺血性中风导致的吞咽困难的文章，包括有随机对照的，无对照的和个案的，作者指出当前的研究文献中缺乏对随机方法的描述，缺乏对针刺位点，针刺操作手法，治疗时间，疗效评估，治疗依从性分析的统一标准，）因此，众多文章中对针灸治疗中风性吞咽困难得疗效的合理性和有效性实在有限。为进一步确证针灸对缺血性中风治疗提供有效可靠的临床证据，必须依照循证医学的原则，采取符合循证医学的手段来改进我们的临床实验，特别是要寻找有利于进行艾炙研究的最佳模型以利未来。
*成都中医药大学的人写的——–堡垒最容易从内部攻破

5． Cochrane Database Syst Rev. 2006 Jul 19;3:CD004870.，Acupuncture for neck disorders.
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.
*中等证据，短期追踪

6． Cochrane Database Syst Rev. 2006 Jan 25;(1):CD000009.，Acupuncture and related interventions for smoking cessation.
There is no consistent evidence that acupuncture, acupressure, laser therapy or electrostimulation are effective for smoking cessation, but methodological problems mean that no firm conclusions can be drawn.
没有一致的证据表明针灸，针压，激光治疗或电刺激发对于戒烟有效，然而由于方法学的原因无法得到明确的结论。
*该文还有更多详细的负面评论，有兴趣的可以自己看

7．Cochrane Database Syst Rev. 2004;(3):CD003281，Stimulation of the wrist acupuncture point P6 for preventing postoperative nausea and vomiting.
This systematic review supports the use of P6 acupoint stimulation in patients without antiemetic prophylaxis. Compared with antiemetic prophylaxis, P6 acupoint stimulation seems to reduce the risk of nausea but not vomiting.
*总算是有个比较正面的评价，但是，也只是对没有采取其他呕吐预防措施的病人；并且，相对于其他呕吐预防措施，也只是能减少欲呕的感觉却并不减少呕吐。

8． Cochrane Database Syst Rev. 2001;(2):CD003008.，Transcutaneous electrical nerve stimulation (TENS) for chronic low back pain.
The results of the meta-analysis present no evidence to support the use of TENS in the treatment of chronic low back pain.
*当然，可以辩解说这不是针灸，只是其中包括了98个类似针灸的TENs实验

9． Cochrane Database Syst Rev. 2001;(1):CD002962.，Acupuncture for induction of labour.
MAIN RESULTS: No trials met the inclusion criteria for the systematic review. REVIEWER’S CONCLUSIONS: There is a need for a well designed randomised controlled trial to evaluate the role of acupuncture to induce labour.
*太遗憾了，没有一个实验满足系统性分析的要求，当然，对针灸术士们是个福音：如果接受针灸的孕妇发生流产引发官司，至少可以拿来证明针灸与流产间无确定关系。

10． Cochrane Database Syst Rev. 2000;(4):CD002823.，Transcutaneous electrical nerve stimulation for knee osteoarthritis.
TENS and AL-TENS are shown to be effective in pain control over placebo in this review. Heterogeneity of the included studies was observed, which might be due to the different study designs and outcomes used. More well designed studies with a standardized protocol and adequate number of participants are needed to conclude the effectiveness of TENS in the treatment of OA of the knee.
*别高兴，这还是研究TENs的，本文是2000年的，2001年的在第8篇中；而且虽然本文认为相对于安慰剂有效，但是缺乏标准方法，没有充分的数据的问题仍然被提出来。

11． Pain. 1983 Jun;16(2):111-27.，On the evaluation of the clinical effects of acupuncture.
If the postulated response rate had been envisaged at the onset of the trials here reviewed, then the majority of these trials have very low power at a conventional 5% level of significance. It is emphasised that one cannot necessarily conclude from trials which produce statistically non-significant results that acupuncture (when compared with placebo for example) is ineffective.
*虽然零概率事件也可能发生，所以我会去买彩票，但一旦有病，至少我不会把有限的经济资源放在这5%上。