Department of Neurology, University of Vermont, Burlington, VT 05405, USA.
Evid Based Complement Alternat Med. 2011;2011:180805. doi: 10.1155/2011/180805. Epub 2010 Oct 11.
In November 2007, the Society for Acupuncture Research (SAR) held an international symposium to mark the 10th anniversary of the 1997 NIH Consensus Development Conference on Acupuncture. The symposium presentations revealed the considerable maturation of the field of acupuncture research, yet two provocative paradoxes emerged. First, a number of well-designed clinical trials have reported that true acupuncture is superior to usual care, but does not significantly outperform sham acupuncture, findings apparently at odds with traditional theories regarding acupuncture point specificity. Second, although many studies using animal and human experimental models have reported physiological effects that vary as a function of needling parameters (e.g., mode of stimulation) the extent to which these parameters influence therapeutic outcomes in clinical trials is unclear. This White Paper, collaboratively written by the SAR Board of Directors, identifies gaps in knowledge underlying the paradoxes and proposes strategies for their resolution through translational research. We recommend that acupuncture treatments should be studied (1) "top down" as multi-component "whole-system" interventions and (2) "bottom up" as mechanistic studies that focus on understanding how individual treatment components interact and translate into clinical and physiological outcomes. Such a strategy, incorporating considerations of efficacy, effectiveness and qualitative measures, will strengthen the evidence base for such complex interventions as acupuncture.
2007 年 11 月，针灸研究学会（SAR）举行了一次国际研讨会，以纪念 1997 年 NIH 针灸共识发展会议十周年。研讨会的报告揭示了针灸研究领域的相当成熟，但出现了两个有争议的悖论。首先，一些精心设计的临床试验报告表明，真正的针灸优于常规护理，但并不明显优于假针灸，这一发现显然与传统的关于穴位特异性的理论相矛盾。其次，尽管许多使用动物和人体实验模型的研究报告了与针刺参数（如刺激模式）相关的生理效应，但这些参数在临床试验中对治疗效果的影响程度尚不清楚。这份白皮书由 SAR 董事会共同撰写，确定了悖论背后的知识差距，并提出了通过转化研究解决这些悖论的策略。我们建议对针灸治疗进行研究：（1）“自上而下”作为多成分“整体系统”干预措施；（2）“自下而上”作为机制研究，重点是了解单个治疗成分如何相互作用并转化为临床和生理结果。这种策略考虑了疗效、有效性和定性措施，将为针灸等复杂干预措施提供更有力的证据基础。
