Over the last 20 years Volker has spent much time trying to find frameworks for understanding East Asian medicines in a manner that does not impose on them our modern needs and our ways of imagining the world, yet allowing for comparison and critique. He believes that such frameworks are essential not merely for historians but also for practitioners seeking to develop their tradition unfettered from the dominance of modern Western concepts. These concepts are not restricted to biomedical science but also include apparent alternatives, such as holism, systems thinking, and the dream of a pure tradition located in the ‘classics' to which we can return.
In his presentation, Volker will argue that in order to accomplish these goals, we might think of medical practice as primarily a problem solving activity. Developing different styles is one way in which East Asian medicines have tried to resolve the problems of medical practice that have confronted them at different historical moments. Understanding these interconnections can help us to develop the potential of East Asian medicines in relation to our own practices and also has important implications for clinical research.
This presentation reports on a study to develop and implement evidence-based clinical practice guidelines for the treatment of frequently diagnosed diseases in the field of traditional Korean medicine. Standard reporting guidance was developed in the form of a checklist and description of items and examples. This included 5 items and 40 sub-items and was designed to improve the reporting of CPGs in traditional medicine, thereby facilitating their interpretation and replication.
Clinical practice guidelines for traditional Korean medicine have been developed for seven disease entities: facial palsy, herniation of the lumbar vertebra, atopic dermatitis, ankle sprain, shoulder-arm pain, obesity and depression. Randomized clinical studies were then conducted to evaluate the applicability of these guidelines, by comparing treatment outcomes from practitioner groups who were given the CPG information in a leaflet against those who were not given this information.
This presentation covers two major projects on pattern identification, for stroke and for blood stasis. The 9-year stroke project ran from 2005 to 2013 and was divided into three 3-year stages. The objective of the ﬁrst phase was to standardize stroke diagnosis using pattern identiﬁcation, to create a standard clinical chart with a combination of TKM and Western medicine, and to construct a biobank and ﬁnd biomarkers associated with patterns of stroke. The objective of the second and third stages was validation and confirmation of the standardised patterns developed in the first phase, using clinical data and candidate biomarkers. Data from 4,921 stroke patients were collected and this presentation will show the process of developing standardized traditional diagnostic methods for pattern identification and their clinical application.
The second part of the talk focuses on the diagnosis of the blood stasis pattern in Chinese Medicine. This is characterised by stagnation, including extravasated blood and sluggish blood circulation or viscous or congested blood, all of which may become pathogenic factors. Blood stasis is associated with chronic and incurable disease, such as pain, infertility, cancer and health conditions caused by stress, which are not curable with modern medicine. A community-based, multi-centre trial was designed as an observational study, with data collected in order to standardise blood stasis diagnosis in Korea. This presentation will show the modern concept of blood stasis by developing a diagnostic tool and diagnostic indices for blood stasis, identify the biological indices and pathological mechanisms related to blood stasis, construct a clinical study base and database for diagnosing and treating blood stasis, and establish traditional Korean medicine diagnoses and treatments for blood stasis disease.
Over the last 20 years, many clinical trials have attempted to assess the benefits of acupuncture on IVF treatment but they have all differed in study design, protocol, outcome measures and commercial bias. This heterogeneity has precluded any firm conclusion regarding the efficacy or otherwise of acupuncture in this field. To address this heterogeneity, and to try and provide an evidence based conclusion , it was decided to adopt the Delphi consensus protocol which was reached in 2012 via 15 international acupuncturists with extended experience in treating women with acupuncture during IVF. This protocol was recommended for future research (Smith et al 2012) but so far has not been implemented: this is the first study to use it.
The study was a randomised controlled trial which was conducted over 2 years at the fertility department of the Homerton hospital in London. The primary end point was live birth rate.
The final results show a large difference between the acupuncture group and the control group in favour of acupuncture. The acupuncture group was found to be superior for both positive pregnancy tests and live birth rates.
The results of this study suggest that acupuncture should be offered as a possible method of improving IVF outcome. This study is the first to follow a widely approved consensus protocol hoping to settle disagreement in the literature and resolve previous disparity.
The Acupuncture Trialists Collaboration published a seminal paper on acupuncture for chronic pain in 2012, which already has been cited over 500 times. The chronic pain conditions included back and neck pain, shoulder pain, osteoarthritis and headache and migraine. In this presentation Hugh will provide an update of the results, with the addition of data from 10 more trials published between 2008 and 2015, totalling of 39 trials and over 20,000 patients.
The findings reinforce the message of the original meta-analysis, namely that acupuncture has a moderate effect when compared to non-acupuncture controls (such as usual care or wait-list) and a small effect when compared to sham acupuncture. The main criticism of the study, that the difference between acupuncture and sham is too small to be meaningful, will be addressed by comparing effect sizes across a range of interventions vs. sham or placebo. Also new data will be presented on the trajectory of reported outcomes, estimating that only 15% of the benefit is lost at 12 months after treatment.
Mark stepped in due to technical problems that stopped the intended web based discussion with Anxiety UK.