AJACM

2008 Volume 3 Issue 1 Abstracts

Acupuncture for Migraine: A Systematic Review of Chinese Literature (Wang, Zheng & Xue)

Chinese Medicine and the Yi Jing's Epistemic Methodology (Qu & Garvey)

Modern Applications of Modified Ban Xia Xie Xin Tang and Their Development (Xu & Zhang)

SOPE: A Model for Developing Online Materials in Chinese Herbal Medicine Education (Wu et al)

Chinese Herbal Medicine for Primary Dysmenorrhoea: A Systematic Review (Zhu et al)

Wang YY, Zheng Z, Xue CCL. Acupuncture for migraine: a systematic review of Chinese literature. Aust J Acupunct Chin Med 2008;3(1):3-16.
Introduction: Acupuncture is widely used for the treatment of migraine, but its effectiveness is inconclusive based on findings of two recent systematic reviews. However, these reviews included very few studies conducted in Asian countries. Research papers published in Chinese are yet to be reviewed to determine their role in the overall understanding of the effectiveness and safety of acupuncture for migraine. Objectives: Is acupuncture more effective than no treatment, sham/placebo acupuncture, or as effective as other interventions for migraine? Methods: Search Strategies: Electronic search was performed in the two most comprehensive Chinese e-databases, Vi Pu and Wan Fang.  Keywords used were a combination of acupuncture, headache, migraine, Chinese medicine, electroacupuncture and point-stimulation.  Selection Criteria: Randomised, controlled trials comparing acupuncture with any type of control interventions and reporting at least one of the clinically related outcome measures for migraine were selected.  Data collection and Analysis: Characteristics of the studies were extracted by two independent reviewers.  Reporting quality and validity were assessed using the Jadad Scale, Internal Validity Scale and Oxford Pain Validity Scale.  STRICTA was used to assess the reporting quality of acupuncture treatment.  RevMan 4.2 was used for data analysis.  Results:  Seventeen studies with a total of 2097 participants (median 91; range 62-216) met the inclusion criteria.  Ten studies compared acupuncture alone with western medications.  The remaining seven trials compared a combined therapy of acupuncture and other therapies with western medications.  None of the studies compared acupuncture with no-treatment control or sham/placebo acupuncture.  None of the 17 studies was considered of high quality.  Studies indicated that acupuncture alone was superior to western medications (RR 1.55, 95% CI 1.27 to 1.88).  In comparison to studies included in the other two reviews, the Chinese studies in this review had a larger sample size and acupuncture treatments were more frequent.  Conclusion:  There is moderate evidence that acupuncture is more effective than western pharmacotherapy.  Due to the poor quality and validity of included studies, this conclusion requires further assessment.  Data from Chinese literature should be included in future systematic reviews. 
KEYWORDS:  systematic review, acupuncture, migraine, headache. 

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Qu L, Garvey M. Chinese medicine and the Yi Jing's epistemic methodology. Aust J Acupunct Chin Med 2008;3(1):17-23.
Traditional Chinese medicine and contemporary biomedicine have developed methodologies that observe and investigate the human body from different epistemological perspectives. Their conceptual differences have been a recurring topic in the West. The contribution of our article to this topic draws on the ontological and epistemological insights found in the Yi Jing (Book of Changes).  Readers will already be familiar with the argument that Chinese medicine has been profoundly influenced by the Yi Jing's use of yin-yang theory.  This paper offers a fresh perspective by examining the Great Commentary's dao-xiang-qi cosmology.  'Dao-xiang-qi' stands for abstract principles, emergent manifestations, and concrete objects, respectively, and this triadic conception of reality leads to an analysis of the human body from a holistic, process-oriented epistemology.  The interpretations of reality and being contained in the Yi Jing were developed by careful and detailed observation over time, and have deeply influenced China's philosophical and scientific traditions, including medicine.  The effect of the dao-xiang-qi (way-image-vessel) triad on Chinese medicine has lead to its characteristic dao xiang epistemic: investigations of human health and illness focus on the living body and result in a more functional or process-oriented epistemic. Relatively speaking, biomedical investigations are guided by a qi-vessel epistemic that places more importance on objective, physicalist information and on quantitative and concrete data.  The purpose of this paper is to explore the Yi Jing's influence on medical epistemics and the influence of dao-xiang-qi for Chinese medical investigations and methodologies.  The paper does not attempt an analysis of biomedical epistemics but inevitably the discussion touches on issues pertaining to the integration of Chinese medicine and biomedicine occurring in recent times.  Integration presupposes some degree of philosophical and methodological commonality and to that extent we draw attention to the ontological and epistemological assumptions of both medicines. 
KEYWORDS:  biomedicine, Chinese medicine, epistemology, integration, materialism, methodology, ontology, Yi Jing (Book of Changes).

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Xu H, Zhang WX. Modern applications of modified Ban Xia Xie Xin Tang and their development. Aust J Acupunct Chin Med 2008;3(1):25-30.
Traditional Chinese medicine (TCM) classic formulae have evolved over hundreds of years; however, their applications and modifications can be further developed. The classic formula Ban Xia Xie Xin Tang (Pinellia Decoction to Drain the Epigastrum; BXXXT), which was originally prescribed by Zhang Zhong-Jing in the Han dynasty (150-219), can be modified and used flexibly in treating various abdominal disorders.  In the Qing dynasty (1644-1911), Wu Ju-Tong (1758-1836) wrote the book Wen Bing Tiao Bian (Systematised Identification of Warm Pathogen Diseases), outlining his eight modifications to BXXXT based on Ye Tian-Shi's (1667-1746) clinical applications of BXXXT and its patterns.  Ye applied BXXXT in two main ways.  The first involved the use of bitter, pungent, dispersing and purging herbs to treat damp heat;  the second was used to purge jue yin and unblock yang ming in order to treat various symptoms caused by Liver wood attacking Stomach earth.  Wu followed Ye's methodology and developed eight modifications to BXXXT.  These can treat summer heat-damp (shu shi), lurking summer heat (fu shu) and damp-warm (shi wen) conditions.  They can also treat jue yin Liver conditions or Liver Qi attacking Stomach patterns.  This article discusses the use of Wu Ju-Tong's eight modifications.  Modern clinical cases including nausea, vomiting, abdominal distension, stomach ache, diarrhoea and infertility have been used as examples to illustrate the flexible use of BXXXT.
KEYWORDS:  Chinese herbal formula, Ban Xia Xie Xin Tang, Wen Bing, abdominal disorders, patterns of disharmony.

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Wu Q, Yang AWH, Mansu S, Radloff A, Zhang AL, Xue CCL et al. SOPE: A model for developing online materials in chinese herbal medicine education. Aust J Acupunct Chin Med 2008;3(1):31-36.
The application of online materials to support classroom teaching may increase the flexibility of students' access to course information and facilitate communication between teachers and students. Quality assurance is the key to the development of online materials. Chinese medicine degree training has recently been introduced into higher education systems of the western world. We have recently adapted a four-stage model (SOPE), including strategic planning, operational practice, product implementation, and evaluation, into the development of online materials for a Chinese medicine subject - Pharmacology of Chinese Medicine. Following this model, information on 350 individual Chinese herbs has been presented at RMIT's Distributed Learning System to facilitate learning and teaching. This paper describes the process of this development with a focus on activities and their quality criteria at the four stages. Findings from this study demonstrate the applicability of the SOPE model in the development of online materials for primary healthcare practitioner training, such as Chinese medicine. Further study is required to conduct formal evaluation of the proposed model and its effective implementation in other educational disciplines.
KEYWORDS: quality assurance, case study, Chinese medicine education.

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Zhu XS, Proctor M, Bensoussan A, Smith C, Wu E et al. Chinese herbal medicine for primary dysmenorrhoea: a systematic review. Aust J Acupunct Chin Med 2008;3(1):37-52.
Background: Conventional treatment for primary dysmenorrhoea has a failure rate of 20% to 25% and may be contraindicated or not tolerated by some women. Chinese herbal medicine may be a suitable alternative. Objectives: To determine the efficacy and safety of Chinese herbal medicine for primary dysmenorrhoea when compared with placebo, no treatment, and other treatment. Main results: Thirty-nine randomised controlled trials involving a total of 3475 women were included in the review. A number of the trials were of small sample size and poor methodological quality. Results for Chinese herbal medicine compared to placebo were unclear as data could not be combined (3 RCTs). Chinese herbal medicine resulted in significant improvements in pain relief (14 RCTs; RR 1.99, 95% CI 1.52 to 2.60), overall symptoms (6 RCTs; RR 2.17, 95% CI 1.73 to 2.73) and use of additional medication (2 RCTs; RR 1.58, 95% CI 1.30 to 1.93) when compared to use of pharmaceutical drugs. Self-designed Chinese herbal formulae resulted in significant improvements in pain relief (18 RCTs; RR 2.06, 95% CI 1.80 to 2.36), overall symptoms (14 RCTs; RR 1.99, 95% CI 1.65 to 2.40) and use of additional medication (5 RCTs; RR 1.58, 95% CI 1.34 to 1.87) after up to three months of follow-up when compared to commonly used Chinese herbal health products. Chinese herbal medicine also resulted in better pain relief than acupuncture (2 RCTs; RR 1.75, 95% CI 1.09 to 2.82) and heat compression (1 RCT; RR 2.08, 95% CI 2.06 to 499.18). Reviewers' conclusions: The review found promising evidence supporting the use of Chinese herbal medicine for primary dysmenorrhoea; however, results are limited by the poor methodological quality of the included trials.
KEYWORDS: traditional Chinese medicine, dysmenorrhoea, review.

[Back to Top]

Acupuncture for Migraine: A Systematic Review of Chinese Literature (Wang, Zheng & Xue)

Chinese Medicine and the Yi Jing's Epistemic Methodology (Qu & Garvey)

Modern Applications of Modified Ban Xia Xie Xin Tang and Their Development (Xu & Zhang)

SOPE: A Model for Developing Online Materials in Chinese Herbal Medicine Education (Wu et al)

Chinese Herbal Medicine for Primary Dysmenorrhoea: A Systematic Review (Zhu et al)

Wang YY, Zheng Z, Xue CCL. Acupuncture for migraine: a systematic review of Chinese literature. Aust J Acupunct Chin Med 2008;3(1):3-16.
Introduction: Acupuncture is widely used for the treatment of migraine, but its effectiveness is inconclusive based on findings of two recent systematic reviews. However, these reviews included very few studies conducted in Asian countries. Research papers published in Chinese are yet to be reviewed to determine their role in the overall understanding of the effectiveness and safety of acupuncture for migraine. Objectives: Is acupuncture more effective than no treatment, sham/placebo acupuncture, or as effective as other interventions for migraine? Methods: Search Strategies: Electronic search was performed in the two most comprehensive Chinese e-databases, Vi Pu and Wan Fang.  Keywords used were a combination of acupuncture, headache, migraine, Chinese medicine, electroacupuncture and point-stimulation.  Selection Criteria: Randomised, controlled trials comparing acupuncture with any type of control interventions and reporting at least one of the clinically related outcome measures for migraine were selected.  Data collection and Analysis: Characteristics of the studies were extracted by two independent reviewers.  Reporting quality and validity were assessed using the Jadad Scale, Internal Validity Scale and Oxford Pain Validity Scale.  STRICTA was used to assess the reporting quality of acupuncture treatment.  RevMan 4.2 was used for data analysis.  Results:  Seventeen studies with a total of 2097 participants (median 91; range 62-216) met the inclusion criteria.  Ten studies compared acupuncture alone with western medications.  The remaining seven trials compared a combined therapy of acupuncture and other therapies with western medications.  None of the studies compared acupuncture with no-treatment control or sham/placebo acupuncture.  None of the 17 studies was considered of high quality.  Studies indicated that acupuncture alone was superior to western medications (RR 1.55, 95% CI 1.27 to 1.88).  In comparison to studies included in the other two reviews, the Chinese studies in this review had a larger sample size and acupuncture treatments were more frequent.  Conclusion:  There is moderate evidence that acupuncture is more effective than western pharmacotherapy.  Due to the poor quality and validity of included studies, this conclusion requires further assessment.  Data from Chinese literature should be included in future systematic reviews. 
KEYWORDS:  systematic review, acupuncture, migraine, headache. 

[Back to Top]

Qu L, Garvey M. Chinese medicine and the Yi Jing's epistemic methodology. Aust J Acupunct Chin Med 2008;3(1):17-23.
Traditional Chinese medicine and contemporary biomedicine have developed methodologies that observe and investigate the human body from different epistemological perspectives. Their conceptual differences have been a recurring topic in the West. The contribution of our article to this topic draws on the ontological and epistemological insights found in the Yi Jing (Book of Changes).  Readers will already be familiar with the argument that Chinese medicine has been profoundly influenced by the Yi Jing's use of yin-yang theory.  This paper offers a fresh perspective by examining the Great Commentary's dao-xiang-qi cosmology.  'Dao-xiang-qi' stands for abstract principles, emergent manifestations, and concrete objects, respectively, and this triadic conception of reality leads to an analysis of the human body from a holistic, process-oriented epistemology.  The interpretations of reality and being contained in the Yi Jing were developed by careful and detailed observation over time, and have deeply influenced China's philosophical and scientific traditions, including medicine.  The effect of the dao-xiang-qi (way-image-vessel) triad on Chinese medicine has lead to its characteristic dao xiang epistemic: investigations of human health and illness focus on the living body and result in a more functional or process-oriented epistemic. Relatively speaking, biomedical investigations are guided by a qi-vessel epistemic that places more importance on objective, physicalist information and on quantitative and concrete data.  The purpose of this paper is to explore the Yi Jing's influence on medical epistemics and the influence of dao-xiang-qi for Chinese medical investigations and methodologies.  The paper does not attempt an analysis of biomedical epistemics but inevitably the discussion touches on issues pertaining to the integration of Chinese medicine and biomedicine occurring in recent times.  Integration presupposes some degree of philosophical and methodological commonality and to that extent we draw attention to the ontological and epistemological assumptions of both medicines. 
KEYWORDS:  biomedicine, Chinese medicine, epistemology, integration, materialism, methodology, ontology, Yi Jing (Book of Changes).

[Back to Top]

Xu H, Zhang WX. Modern applications of modified Ban Xia Xie Xin Tang and their development. Aust J Acupunct Chin Med 2008;3(1):25-30.
Traditional Chinese medicine (TCM) classic formulae have evolved over hundreds of years; however, their applications and modifications can be further developed. The classic formula Ban Xia Xie Xin Tang (Pinellia Decoction to Drain the Epigastrum; BXXXT), which was originally prescribed by Zhang Zhong-Jing in the Han dynasty (150-219), can be modified and used flexibly in treating various abdominal disorders.  In the Qing dynasty (1644-1911), Wu Ju-Tong (1758-1836) wrote the book Wen Bing Tiao Bian (Systematised Identification of Warm Pathogen Diseases), outlining his eight modifications to BXXXT based on Ye Tian-Shi's (1667-1746) clinical applications of BXXXT and its patterns.  Ye applied BXXXT in two main ways.  The first involved the use of bitter, pungent, dispersing and purging herbs to treat damp heat;  the second was used to purge jue yin and unblock yang ming in order to treat various symptoms caused by Liver wood attacking Stomach earth.  Wu followed Ye's methodology and developed eight modifications to BXXXT.  These can treat summer heat-damp (shu shi), lurking summer heat (fu shu) and damp-warm (shi wen) conditions.  They can also treat jue yin Liver conditions or Liver Qi attacking Stomach patterns.  This article discusses the use of Wu Ju-Tong's eight modifications.  Modern clinical cases including nausea, vomiting, abdominal distension, stomach ache, diarrhoea and infertility have been used as examples to illustrate the flexible use of BXXXT.
KEYWORDS:  Chinese herbal formula, Ban Xia Xie Xin Tang, Wen Bing, abdominal disorders, patterns of disharmony.

[Back to Top]

Wu Q, Yang AWH, Mansu S, Radloff A, Zhang AL, Xue CCL et al. SOPE: A model for developing online materials in chinese herbal medicine education. Aust J Acupunct Chin Med 2008;3(1):31-36.
The application of online materials to support classroom teaching may increase the flexibility of students' access to course information and facilitate communication between teachers and students. Quality assurance is the key to the development of online materials. Chinese medicine degree training has recently been introduced into higher education systems of the western world. We have recently adapted a four-stage model (SOPE), including strategic planning, operational practice, product implementation, and evaluation, into the development of online materials for a Chinese medicine subject - Pharmacology of Chinese Medicine. Following this model, information on 350 individual Chinese herbs has been presented at RMIT's Distributed Learning System to facilitate learning and teaching. This paper describes the process of this development with a focus on activities and their quality criteria at the four stages. Findings from this study demonstrate the applicability of the SOPE model in the development of online materials for primary healthcare practitioner training, such as Chinese medicine. Further study is required to conduct formal evaluation of the proposed model and its effective implementation in other educational disciplines.
KEYWORDS: quality assurance, case study, Chinese medicine education.

[Back to Top]

Zhu XS, Proctor M, Bensoussan A, Smith C, Wu E et al. Chinese herbal medicine for primary dysmenorrhoea: a systematic review. Aust J Acupunct Chin Med 2008;3(1):37-52.
Background: Conventional treatment for primary dysmenorrhoea has a failure rate of 20% to 25% and may be contraindicated or not tolerated by some women. Chinese herbal medicine may be a suitable alternative. Objectives: To determine the efficacy and safety of Chinese herbal medicine for primary dysmenorrhoea when compared with placebo, no treatment, and other treatment. Main results: Thirty-nine randomised controlled trials involving a total of 3475 women were included in the review. A number of the trials were of small sample size and poor methodological quality. Results for Chinese herbal medicine compared to placebo were unclear as data could not be combined (3 RCTs). Chinese herbal medicine resulted in significant improvements in pain relief (14 RCTs; RR 1.99, 95% CI 1.52 to 2.60), overall symptoms (6 RCTs; RR 2.17, 95% CI 1.73 to 2.73) and use of additional medication (2 RCTs; RR 1.58, 95% CI 1.30 to 1.93) when compared to use of pharmaceutical drugs. Self-designed Chinese herbal formulae resulted in significant improvements in pain relief (18 RCTs; RR 2.06, 95% CI 1.80 to 2.36), overall symptoms (14 RCTs; RR 1.99, 95% CI 1.65 to 2.40) and use of additional medication (5 RCTs; RR 1.58, 95% CI 1.34 to 1.87) after up to three months of follow-up when compared to commonly used Chinese herbal health products. Chinese herbal medicine also resulted in better pain relief than acupuncture (2 RCTs; RR 1.75, 95% CI 1.09 to 2.82) and heat compression (1 RCT; RR 2.08, 95% CI 2.06 to 499.18). Reviewers' conclusions: The review found promising evidence supporting the use of Chinese herbal medicine for primary dysmenorrhoea; however, results are limited by the poor methodological quality of the included trials.
KEYWORDS: traditional Chinese medicine, dysmenorrhoea, review.

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