침에 대한 정서와 인지요소 분석

채윤병,박히준,강오석,이정찬,박경모,이혜정 대한침구의학회 2007 대한침구의학회지 Vol.24 No.3

Objectives : Placebo phenomena have been considered as a confounding factor of clinical trial. Expectancy and belief of acupuncture have not been evaluated quantitatively. The present study was performed to analyze the emotional and cognitive factor of acupuncture and investigate whether the expectancy of acupuncture treatment is associated with the cognition of acupuncture. Methods : The expectancy and the perception of bodily sensation (PBS) of 22 participants were assessed using self-reported questionnaire. The subjects used the self assessment manikin (SAM) to rate each of the standard affective image of the international affective picture system (IAPS) and other acupuncture-related image. Based on the degree of expectancy, the high expectant (HE) and the low expectant (LE) group were classified. The thermal and pressure pain threshold was objectively evaluated using radiant-heat device and algometer. The degree of expected pain of acupuncture and the actual pain of painful stimulation was subjectively evaluated using facial pain scales (FPS).Results : Using SAM analysis, we identified the negative correlation between hedonic valence and arousal dimension on acupuncture-related visual cue. The degree of the PBS and general pain threshold did not show any significant difference between the HE and the LE group. The HE group rated the acupuncture images as more pleasant, more arousing, than the LE group. In addition, we also found that the higher expectancy marked the lower FPS of the expected pain of acupuncture, but not of the actual pain of painful stimulation. Conclusions : Our preliminary study identified the psychological dimensions of acupuncture-related visual cue. These findings indicate that the expectancy of acupuncture could affect the cognition of acupuncture.

황련해독탕 약침, 자하거 약침의 침감에 대한 임상적 연구 - placebo 약침을 위한 기초연구 (2) -

윤종석,서정철,이향숙,임성철,정태영,신임희,한상원,Yoon, Jong-seok,Seo, Jung-chul,Lee, Hyang-sook,Lim, Seong-cheol,Jung, Tae-young,Shin, Leem-hee,Han, Sang-won 대한침구의학회 2004 대한침구의학회지 Vol.21 No.4

Objective : This study was designed to find out whether NS(normal saline) is able to be constituted as an appropriate control group for HHT(Hwangryunhaedoktang herbal acupuncture) and HP(Homnis Placenta herbal acupuncture). Methods : NS and two herbal acupuncture were inserted into Quchi(LI 11) of the subjects. After 5 minutes the subjects completed a questionnaire rating the intensity of 21 kinds of acupuncture sensation; hurting, penetrating, sharp, aching, intense, spreading, radiating, tingling, pricking, stinging, pulling, heavy, dull, numb, electric, shocking, hot, burning, cool, pulsing, and throbbing. We compared the subjective acupuncture sensation between the two groups. Results : As for HHT seven items of the acupuncture sensation were significantly different from NS. In case of HP just two items were significantly different from NS. Conclusion : We found that NS may be able to be an placebo herbal acupuncture for HP. Further study is needed for the appropriate placebo herbal acupuncture.

침 임상연구에 사용된 거짓침의 분석

장진영,김소정,김남식,남상수,김용석 대한침구의학회 2011 대한침구의학회지 Vol.28 No.5

Objectives : Recent well-designed randomized controlled trials(RCTs) and their meta-analysis have been published on the efficacy of acupuncture in different condition. In most of them, real acupuncture is compared with sham acupuncture including invasive and non-invasive sham methods. But it is not clear how active sham methods are. These results tend to lead the conclusion that acupuncture has no more effective than sham acupuncture. In order to investigate that sham acupuncture is appropriate as a control, we reviewed several acupuncture trials using different sham acupuncture as a control. Methods : We searched Cochrane researches of acupuncture, reviewed and analyzed 25 RCTs in 42 Cochrane reviews. And especially we compared the effect of acupuncture according to the type of sham acupuncture. Results : Invasive sham acupunctures are used in 12 RCTs and non-invasive types are used in the rest. The majority of studies(19 RCTs) fail to show effects beyond a sham acupuncture. Streitberger’s sham needle is a validated sham acupuncture of non-invasive type that was used in 8 trials and also no significant group differences are shown except one trial. Conclusions : Acupuncture is a complex intervention. Clinical trials of acupuncture need to be reexamined and redesigned to remove several bias. Especially, sham acupuncture as a control might be investigated for physiological effects as well as validation test including patient-blinding and de qi sensation. Other research need to be investigated and developed for acupuncture trials.

Non-penetrating sham needle, is it an adequate sham control in acupuncture research?

Lee, Hyangsook,Bang, Heejung,Kim, Youngjin,Park, Jongbae,Lee, Sangjae,Lee, Hyejung,Park, Hi-Joon Elsevier 2011 Complementary therapies in medicine Vol.19 No.suppl1

<P><B>Summary</B></P><P><B>Objectives</B></P><P>This study aimed to determine whether a non-penetrating sham needle can serve as an adequate sham control.</P><P><B>Design</B></P><P>We conducted a randomised, subject-blind, sham-controlled trial in both acupuncture-naïve and experienced healthy volunteers.</P><P><B>Setting and interventions</B></P><P>Participants were randomly allocated to receive either real acupuncture (<I>n</I>=39) or non-penetrating sham acupuncture (<I>n</I>=40) on the hand (LI4), abdomen (CV12) and leg (ST36). The procedures were standardised and identical for both groups.</P><P><B>Main outcome measures</B></P><P>Participants rated acupuncture sensations on a 10-point scale. A blinding index was calculated based on the participants’ guesses on the type of acupuncture they had received (real, sham or do not know) for each acupuncture point. The association of knowledge about and experience in acupuncture with correct guessing was also examined.</P><P><B>Results</B></P><P>The subjects in both groups were similar with respect to age, gender, experience or knowledge about acupuncture. The sham needle tended to produce less penetration, pain and soreness only at LI4. Blinding appeared to be successfully achieved for ST36. Although 41% of participants in the real acupuncture group made correct guesses for LI4, 31% guessed incorrectly for CV12, beyond chance level. People with more experience and knowledge about acupuncture were more likely to correctly guess the type of needle they received at ST36 only, compared to that at the other points.</P><P><B>Conclusions</B></P><P>A non-penetrating sham needle may successfully blind participants and thus, may be a credible sham control. However, the small sample size, the different needle sensations, and the degree and direction of unblinding across acupuncture points warrant further studies in Korea as well as other countries to confirm our finding. Our results also justify the incorporation of formal testing of the use of sham controls in clinical trials of acupuncture.</P>

침의 진통효과: 체성감각신경자극으로 유도된 진통작용에 대한 기능성자기공명영상장치를 이용한 연구

조장희,황선출,손영돈,강창기,Edward K.Wong,배선준,이언정,성강경,박태석,김영보,민훈기,Terry Oleson 대한침구의학회 2004 대한침구의학회지 Vol.25 No.1

Objective : Physiological evidence regarding acupuncture’s effect in human patients is not yet well established, despite considerable evidence for its therapeutic efficacy. Besides target or disease specificity of acupuncture, acupuncture analgesia (AA) appears to be another large subclass that poses many questions, such as whether there is point specificity with respect to which acupoint is most effective for a particular condition. Methods : We observed brain activation with functional magnetic resonance imaging (fMRI) using a set of stimuli that consist of pain, pain following Meridian acupuncture, and pain following Sham acupuncture. Results : Among the new observations, the most interesting fact is that data sets of both Meridian acupuncture and Sham acupuncture show decreased activation of the same brain areas related to the pain processing signals. Present functional MRI study demonstrate two important biological observations that could elucidate AA mechanism in human participants: the effects of acupuncture occur through mediation of the higher brain areas. Sham acupuncture stimulation appears to be almost as effective as traditional Meridian acupoint stimulation, suggesting that acupuncture is not entirely point specific. Decreased activation in the limbic paleo-cortical areas appears to be the probable neurological manifestation of AA and strongly implies that acupuncture stimulation inhibits the transmission of ascending pain signals to the higher cortical areas by the previously known descending pain inhibitory circuit. Conclusion : We, therefore, a hypothesized that this pain inhibitory circuit is initiated and mediated via the broad sense Hypothalamus-Pituitary-Adrenal (BS-HPA) axis in conjunction to the “sensory stimulation.”

침 임상시험 논문에 적용한 Sham Acupuncture에 대한 고찰

정찬영,장민기,조재용,김은정,박인식,김갑성 대한침구의학회 2008 대한침구의학회지 Vol.25 No.6

Objectives : Though there were many clinical studies of acupuncture effects they didn’t have appropriate control group or use another therapy for control group. So, we didn’t say it was true acupuncture effect, though subjects in clinical study improved. Recently several sham needles for control group were developed and validated. This study aimed at summarizing the validation studies of these needles and evaluating the control group of the acupuncture clinical study. Methods : Computerized literature searches were performed using ‘acupuncture’ and ‘placebo or sham’ with a limitation of the results to RCTs in Pubmed, Sciencedirect, NDSL, KISS, RISS. Data were extracted regarding study design, sample size, acupuncture point, stimulation form, credibility testing. And We have examined 106 acupuncture clinical studies published by Pubmed from January 1, 2005 to April 30, 2008. Data were extracted author’s country, subject of study, type of study groups, type of control groups, type of blinding, difference between the results in the control groups. Results : Streitberger’s placebo needle, Fink’s sham needle, Park sham needle, Kim sham needle were developed. They were validated at domestic and abroad. But the results were deviation depending on the each of the researcher. They has shown that sample, acupuncture points, experiences or knowledge of acupuncture dependent on the results. Recent three years, acupuncture clinical trial had different results. Significant differences between Study group and control group emerged from using other therapy or non-treatment for control group. Many study has no significant differences using sham acupuncture for control groups. Conclusions : Acupuncture clinical studies need to meet several requirements. First of all, they require the basics of randomized controlled clinical studies such as blinding and the accurate implementation and description of randomization. And also need to research the unique circumstances of these studies such as the development of sham acupuncture and blinding method which differs from other clinical trials.

족삼리(足三里), 합곡(合谷) 단일(單一) 및 배혈(配穴) 침자(鍼刺)가 상치통(上齒痛) 유발(誘發) 백서(白鼠)의 dEMG에 미치는 영향(影響)

나창수 ( Chang Su Na ),오창록 ( Chang Rock Oh ),조명래 ( Myung Rae Cho ),채우석 ( Woo Seok Chae ) 대한경락경혈학회 2004 Korean Journal of Acupuncture Vol.20 No.1

Objectives: The pain was induced on upper and lower incisor of the rat based on the theory of `connections of upper incisor pain with stomach meridian and lower incisor pain with large intestine meridian`. Such acupoints as LI4 and ST36 were used for alleviation of upper and lower incisor pain. Methods: The digastric myogram (dEMG) was utilized for the pain measurement. Results: The ST36 acupuncture after induction of upper incisor pain was gradually decreased or increased the dEMG. The LI4 acupuncture after induction of upper incisor pain was gradually decreased the dEMG. The ST36+LI4 acupuncture after induction of upper incisor pain was gradually decreased the dEMG. We knew this thing which the ST36+LI4 acupuncture decreased the dEMG most greatly and kept long compared to ST36 acupuncture, LI4 acupuncture. Conclusions: Acupuncture treatment at the loci of not only ST36 acupuncture but LI4 acupuncture were relieved the upper incisor pain. It was well suitable to the theory `connections of upper incisor pain with stomach meridian` that ST36 acupuncture decreased the upper incisor pain. But there was not to decrease the dEMG for the ST36 acupuncture. We are considered as tracing study continuously about ST36 acupuncture. It was not suitable to the theory `connections of upper incisor pain with stomach meridian` that LI4 acupuncture decreased the upper incisor pain. These results was considered as the function by the characteristic of the LI4 acupoint.

플라세보 약침에 대한 무작위배정 임상시험

서정철,Charlie Xue 대한침구의학회 2008 대한침구의학회지 Vol.25 No.6

Objectives : This study was designed to find out whether normal saline(NS) acupuncture is able to be constituted as an appropriate control group for Cervi Cornu Parvum herbal acupuncture(CC). Methods : NS and CC were injected into Quchi(LI11) of the subjects. The subjects completed a questionnaire rating the intensity of 21 kinds of acupuncture sensation(hurting, penetrating, sharp, aching, intense, spreading, radiating, tingling, pricking, stinging, pulling, heavy, dull, numb, electric, shocking, hot, burning, cool, pulsing, and throbbing) and side effects. We compared subjective evaluations of acupuncture sensation and side effects between two groups. Results : As for CC most of the acupuncture sensation items were not significantly different from NS especially in less acupuncture-experienced subjects (average 2, below 10 time experiences) rather than more acupuncture-experienced subjects(above 10 time experiences). Conclusions : We found that NS might be an appropriate placebo herbal acupuncture for CC in small amount of acupuncture-experienced subjects. Further study is needed for new placebo herbal acupuncture for CC in more acupuncture-experienced subjects.

Clinical Effectiveness of Laser Acupuncture: A Systematic Review

G. David Baxter,Chris Bleakley,Suzanne McDonough 사단법인약침학회 2008 Journal of Acupuncture & Meridian Studies Vol.1 No.2

The use of laser light as an alternative to needles to stimulate acupuncture points has been promoted for almost three decades. However, there has been no systematic assessment of the evidence to support the effectiveness of this form of acupuncture to date. A systematic review was therefore undertaken of RCTs evaluating laser acupuncture as a primary intervention. Relevant studies (n = 18) were identified using computer-based literature searches and selected hand searches. Evidence was found to support the use of laser acupuncture in the treatment of myofascial pain, postoperative nausea and vomiting and for the relief of chronic tension headache. Laser acupuncture would appear to represent an effective form of acupuncture for the management of these conditions and could be considered as a viable alternative to more traditional forms of acupuncture point stimulation. The use of laser light as an alternative to needles to stimulate acupuncture points has been promoted for almost three decades. However, there has been no systematic assessment of the evidence to support the effectiveness of this form of acupuncture to date. A systematic review was therefore undertaken of RCTs evaluating laser acupuncture as a primary intervention. Relevant studies (n = 18) were identified using computer-based literature searches and selected hand searches. Evidence was found to support the use of laser acupuncture in the treatment of myofascial pain, postoperative nausea and vomiting and for the relief of chronic tension headache. Laser acupuncture would appear to represent an effective form of acupuncture for the management of these conditions and could be considered as a viable alternative to more traditional forms of acupuncture point stimulation.

Fear of acupuncture enhances sympathetic activation to acupuncture stimulation

Lee, In-Seon,Jo, Hee-Jin,Lee, Soon-Ho,Lee, Hyangsook,Lee, Hyejung,Park, Hi-Joon,Chae, Younbyoung BMJ Publishing Group Ltd 2013 Acupuncture in medicine Vol.31 No.3

<P><B>Background</B></P><P>Acupuncture treatment frequently evokes both pain and fear, causing patients to be hesitant about undergoing the procedure. This study investigated individual differences in autonomic response to acupuncture stimulation and its relationship to fear of the procedure.</P><P><B>Methods</B></P><P>Twenty-seven participants filled out the acupuncture fear scale (AFS) questionnaire and underwent acupuncture stimulation at the LI4 acupuncture point. Autonomic responses were measured by recording the skin conductance response (SCR) throughout acupuncture stimulation. Pearson correlation analysis was performed between the self-reported AFS scores and changes in SCR.</P><P><B>Results</B></P><P>After acupuncture stimulation, SCR significantly increased and there were greater individual differences in enhanced sympathetic activations to acupuncture stimulation. Changes in SCR correlated with scores for the painful sensation domain of the AFS.</P><P><B>Conclusions</B></P><P>Our results indicate that fear of acupuncture-induced pain is associated with physiological arousal when people receive acupuncture stimulation. Fear of pain is the dominant factor in acupuncture-related fear and it should be considered in practice and in research.</P>