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National Library of Medicine
Current Bibliographies in Medicine 97-6
Introduction
ACUPUNCTURE
This bibliography was
prepared in support of the National Institutes of Health (NIH) Consensus
Development Conference on Acupuncture held in Bethesda, MD on November 3-5,
1997. This document was prepared by staff at the National Institute on Drug
Abuse (NIDA) and the National Library of Medicine (NLM), primarily to
facilitate deliberations of the consensus development panel assembled by the
Office of Medical Applications of Research (OMAR) and the Office of
Alternative Medicine (OAM). The authors are mindful that this document may
also serve as a primary bibliographic resource for American physicians and
acupuncturists, as well as the English-speaking public around the world.
With this in mind, searches were conducted with several accessible
computerized databases using a multi-pronged search strategy that aspired to
being comprehensive in an attempt to find clinical data relevant to the use
of acupuncture points. In addition, the entire NLM collection of journals on
the subject of acupuncture, not otherwise indexed and with English-language
articles or summaries (Table I), was hand-searched by a medical
epidemiologist for articles with relevant clinical data.
TABLE I
ACUPUNCTURE JOURNALS HAND SEARCHED
Acupuncture (vol. 1,
1990)
California Journal of Oriental Medicine (Spec Ed 1996)
Giornale Italiano di Riflessoterapia ed Agopuntura (Anno 1, 1989 - Anno 8,
no.1, 1996)
International Journal of Veterinary Medicine (vol. 3, 1992 - vol. 6, 1995)
Needle (vol. 4, 1985 - vol. 6, 1987)
Pacific Journal of Oriental Medicine (no. 1, 1993 - no. 4, 1994 and no. 9
[c1996])
Revue Francais d'Acupuncture (vol. 6, 1980 - vol. 23, no. 90, 1997)
Washington Update of Acupuncture (vol 2, no. 1-7, 1997)
World Journal of Acupuncture (vol. 1, 1991 - vol. 2, 1992)
This bibliography has
also incorporated much of the previous efforts and the organizational
strategy of the Medical Acupuncture Research Foundation (MARF)
bibliographies, compiled primarily by Russell J. Erickson, MD, and
disseminated by the American Academy of Medical Acupuncture (AAMA)*. Most of
the MARF topic sections have been further subdivided into sub-sections
labeled "selected controlled trials" (Section A) and "other data" (Section
B). Computer-indexed articles with descriptors including the terms "random"
and/or "blind" (or variations thereof) were included in section A, along
with hand-searched articles thought by the epidemiologist/searcher to be
particularly useful controlled trials. While many excellent trials and
useful case-series may have been included in section B, the clinician
looking for the quickest and most definitive answers will usually be able to
find many of the most important articles in section A. This bibliography
includes citations indexed from January 1970 through September 1997. For
ongoing acupuncture citations after these dates, the electronic databases
listed in Table II will be very useful for the English-speaking
clinician/researcher. Another resource that may be useful in the future is
ACULARS, the Acupuncture Literature Analysis and Retrieval System, produced
by the Beijing Institute of Information and Library of the Academy of
Traditional Chinese Medicine in Beijing. That database was not utilized for
this bibliography because of its cost and the consideration that most of the
information in ACULARS is not yet available in English.
TABLE II DATABASES
Databases found
to contain numerous unique bibliographic references:
Allied and Alternative Medicine produced by the British Library, Yorkshire,
U.K.
EMBASE® (formerly Excerpta Medica) produced by Elsevier Science B.V.,
Amsterdam
Manual, Alternative and Natural TherapyTM
(MANTISTM) produced
by Action Potential, Inc., Denton, TX
MEDLINE® produced by the National Library of Medicine, Bethesda, MD
Additional databases
useful for veterinary literature:
AGRICOLA produced by the National Agricultural Library, Beltsville, MD
CAB ABSTRACTS produced by CAB International, Wallingford, U.K.
For the purposes of
this conference, the term 'acupuncture' has been defined as "stimulation,
primarily by the use of solid needles, of traditionally and clinically
defined points on and beneath the skin, in an organized fashion for
therapeutic and/or preventive purposes." The original acupuncture points (or
"acupoints") are specific superficial anatomic locations defined in
traditional Asian texts. The skin on or over these points is generally lower
in transdermal electrical resistance than the skin surrounding them. There
is considerable overlap between these traditional acupoints and points
defined by other means in modern physical medicine such as "trigger points,"
"motor points," or "osteopathic lesions" (among other terms). These points
are often palpable subcutaneously as either mild depressions or small and
sometimes tender nodules. In traditional Asian medicine these points are
stimulated either by puncture and manual manipulation of solid needles or by
local heating. Heating is generally accomplished by the burning of dried,
powdered Artemisia vulgaris (moxa), referred to as "moxibustion." This moxa
is either placed or held just above the acupoint by the acupuncturist
(indirect moxibustion), attached to a needle penetrating the point, or
applied directly to the skin (direct moxibustion, generally removed prior to
causing any detectable skin-burn). In modern times, additional methods of
stimulating the acupoints include applications of electric current to
needles in the points or skin electrodes over the points, injections into
the points, laser-light directed onto the points, or finger-pressure massage
of selected points, called "acupressure." In addition, many new points and
whole new systems of points have been described on specific body-parts,
leading to (for instance) scalp-acupuncture, hand-acupuncture, and
ear-acupuncture.
What combination of
acupoints are the best points to stimulate in which ways for various
clinical problems has been the subject of writing and argument for
centuries. Different systems and approaches are associated with various
schools of thought and national traditions in Asia and the West. Acupuncture
practitioners in European countries such as France, Italy, Germany, and
England have evolved their own approaches to the clinical use of acupuncture
points in the past century. Some of these are based on approaches popular at
different times and places in Asian history, or based on diverse
interpretations of traditional Chinese texts, or on different syntheses of
material from these texts with the modern information derived from
neurology, physiology, information theory, and biophysics. Much of the
clinical literature of acupuncture is concerned with descriptions of these
various approaches to clinical problems based on different theories or
schools of thought. Most of that literature has not been included in this
bibliography. While some historical or conceptual pieces have been included
for the sake of completeness, the main purpose of this bibliography has been
to compile citations of articles containing actual clinical data from
defined numbers of human or animal subjects, to help answer the question of
whether or not acupoint stimulation had a detectable and useful effect as
performed in that particular study.
An acupuncture
treatment is a procedure, like surgery or a psychotherapy session, rather
than a drug. For this reason it has been very difficult to subject
acupuncture to the gold-standard of randomized blinded trials (RBTs), and
almost impossible to conduct truly double-blind trials. Much of the clinical
data available for acupuncture consists of case-series, such as those often
reported for new surgical procedures. For areas in which many RBTs are
available (such as the prevention and treatment of nausea and vomiting),
these RBTs are the articles that have been emphasized in this collection.
For areas in which fewer such definitive trials are available, a greater
emphasis has been placed on including large case-series or other sources of
less definitive, but still potentially useful clinical data. In addition,
every attempt has been made to include the most complete possible list of
"side effects" and other adverse events that have been reported in
association with acupuncture. This may have resulted in the inclusion of
multiple descriptions of single adverse events as well as the probable
inclusion of events in which acupuncture was only one of many interventions
being used and may not have been the cause of the "side effect."
This bibliography has
been assembled specifically to help answer the question of whether, based on
the clinical data, acupuncture point therapy is likely to be helpful in a
given clinical problem. It is dedicated to the patients, clinicians, and
researchers who have produced the information indexed here, as well as to
the patients who may benefit from this information in the future. The
authors would like to thank Adam Glazer, Jennie P. Hunt, and Peggie S.
Tillman of the NLM for their assistance.
Any reproductions of
this bibliography, in whole or in part, must include all credits. If you
wish to cite this bibliography, the correct format is:
Klein, Lori J.; Trachtenberg, Alan I., compilers. Acupuncture [bibliography
online]. Bethesda (MD): National Library of Medicine; 1997 Oct [insert cited
year month day in brackets]. [insert no. of screens or lines in brackets].
(Current bibliographies in medicine; no. 97-6). 2302 citations from January
1970 through October 1997. Available from: URL http://www.nlm.nih.gov/pubs/resources.html
* American Academy of
Medical Acupuncture
Medical Acupuncture Research Foundation
5820 Wilshire Blvd. Suite 500
Los Angeles CA 90036
213-937-5514 or 800-521-2262 Fax: 213-937-0959
MARF website:
www.medicalacupuncture.org
Information resource:
http://www.nlm.nih.gov/pubs/cbm/acupuncture.html#115 |
