Price Sarah, Long Andrew F, Godfrey Mary
The Complementary and Integrated Medicine Research Unit, Faculty of Medicine, University of Southampton, Southampton SO16 5ST, UK.
BMC Complement Altern Med. 2014 Jun 25;14:201. doi: 10.1186/1472-6882-14-201.
Despite the increasing popularity of acupuncture, there remains uncertainty as to its effectiveness and how it brings about change. Particular questions are posed over whether acupuncture research has sufficient model validity and reflects acupuncture as practised. Exploring traditional acupuncture (TA) in practice should help to expose processes essential to the theory of TA. The aim of this study was to examine what TA practitioners aim to achieve, their rationale and how they follow this through in their practice.
A longitudinal study of TA for women with early breast cancer (EBC) was performed. Study participants comprised 14 women with EBC and two experienced TA practitioners, all taking part in in-depth interviews, conducted before and after receipt of up to 10 treatment sessions, and analysed using grounded theory methods. Additional data came from practitioner treatment logs and diaries.
Practitioners sought long-term goals of increasing strength and enabling coping as well as immediate relief of symptoms. They achieved this through a continuous process of treatment, following through the recursive and individualized nature of TA and adjusted, via differential diagnosis, to the rapidly fluctuating circumstances of individual women. Establishing trust and good rapport with the women aided disclosure which was seen as essential in order to clarify goals during chemotherapy. This process was carefully managed by the practitioners and the resultant therapeutic relationship was highly valued by the women.
This study provided insight into the interdependent components of TA helping to demonstrate the multiple causal pathways to change through the continuous process of new information, insights and treatment changes. A good therapeutic relationship was not simply something valued by patients but explicitly used by practitioners to aid disclosure which in turn affected details of the treatment. The therapeutic relationship was therefore a vital and integral part of the treatment process.
尽管针灸越来越受欢迎，但其有效性以及它如何带来改变仍存在不确定性。关于针灸研究是否具有足够的模型效度以及是否反映了实际应用中的针灸，存在一些特别的问题。在实践中探索传统针灸（TA）应有助于揭示TA理论的关键过程。本研究的目的是考察TA从业者的目标、他们的理论依据以及他们在实践中如何贯彻这些目标。
对早期乳腺癌（EBC）女性进行了TA的纵向研究。研究参与者包括14名EBC女性和两名经验丰富的TA从业者，他们都参与了在接受多达10次治疗前后进行的深入访谈，并采用扎根理论方法进行分析。额外的数据来自从业者的治疗记录和日记。
从业者追求增强力量和增强应对能力的长期目标以及症状的即时缓解。他们通过持续的治疗过程来实现这一目标，遵循TA的递归性和个体化特点，并通过鉴别诊断进行调整，以适应个体女性快速变化的情况。与女性建立信任和良好的融洽关系有助于她们吐露心声，这被视为在化疗期间明确目标的关键。这个过程由从业者精心管理，由此产生的治疗关系受到女性的高度重视。
本研究深入了解了TA的相互依存成分，有助于通过新信息、见解和治疗变化的持续过程展示改变的多重因果途径。良好的治疗关系不仅是患者重视的东西，也是从业者明确用来帮助吐露心声的手段，而这反过来又影响治疗的细节。因此，治疗关系是治疗过程的重要组成部分。
