Robinson Narda G
Department of Clinical Sciences, Colorado State University, Fort Collins, CO 80526, USA.
Medicines (Basel). 2016 Aug 5;3(3):21. doi: 10.3390/medicines3030021.
As enthusiasm for alternatives to pharmaceuticals and surgery grows, healthcare consumers are turning increasingly to physical medicine modalities such as acupuncture. However, they may encounter obstacles in accessing acupuncture due to several reasons, such as the inability to locate a suitable practitioner, insufficient reimbursement for treatment, or difficulty gaining a referral due to perceived lack of evidence or scientific rigor by specialists. Claims made about a range of treatment paradigms outstrip evidence and students in acupuncture courses are thus led to believe that the approaches they learn are effective and clinically meaningful. Critical inquiry and critical analysis of techniques taught are often omitted, leading to unquestioning acceptance, adoption, and implementation into practice of approaches that may or may not be rational and effective. Acupuncture education for both licensed physicians (DOs and MDs) and non-physicians needs to include science (i.e., explanation of its effects based on contemporary explanations of biological processes), evidence, and critical thinking. Erroneous notions concerning its mechanisms such as moving "stuck Qi (Chi)" or "energy" with needles and that this energy stagnates at specific, tiny locations on the body called acupuncture points lead to mistakes in methodologic design. For example, researchers may select sham and verum point locations that overlap considerably in their neural connections, leading to nonsignificant differences between the two interventions. Furthermore, attributing the effects of acupuncture to metaphorical and arcane views of physiology limits both acceptance and validation of acupuncture in both research and clinical settings. Finally, the content and quality of education and clinical exposure across acupuncture programs varies widely, with currently no minimum basic educational requirements in a scientific methodology. Considering the pressures mounting on clinicians to practice in an evidence-based and scientific manner that also demonstrates cost-effectiveness, acupuncture schools and continuing medical education (CME) courses need to provide their students a strong foundation in rational approaches supported by research.
随着人们对药物和手术替代方案的热情日益高涨，医疗保健消费者越来越多地转向针灸等物理医学疗法。然而，由于多种原因，他们在接受针灸治疗时可能会遇到障碍，比如难以找到合适的从业者、治疗费用报销不足，或者由于专家认为缺乏证据或科学严谨性而难以获得转诊。关于一系列治疗模式的说法缺乏证据，因此针灸课程的学生被误导，认为他们所学的方法是有效的且具有临床意义。对所教授技术的批判性探究和批判性分析常常被忽略，导致人们不加质疑地接受、采用并将这些方法应用于实践，而这些方法可能合理有效，也可能并非如此。针对执业医师（整骨医师和医学博士）和非医师的针灸教育都需要纳入科学内容（即根据当代对生物过程的解释来说明其效果）、证据和批判性思维。关于针灸机制的错误观念，比如用针移动“滞气（气）”或“能量”，以及这种能量在身体上称为穴位的特定微小位置停滞，会导致方法设计上的错误。例如，研究人员可能会选择在神经连接上有相当大重叠的假穴位和真穴位位置，导致两种干预措施之间没有显著差异。此外，将针灸的效果归因于生理学的隐喻性和神秘观点，限制了针灸在研究和临床环境中的接受度和验证。最后，不同针灸课程的教育内容和质量以及临床接触差异很大，目前在科学方法方面没有最低基本教育要求。考虑到临床医生面临着越来越大的压力，需要以循证和科学的方式行医，同时还要证明成本效益，针灸学校和继续医学教育（CME）课程需要为学生提供基于研究支持的合理方法的坚实基础。
