Transcript 2007 Summer Broadening Program Faculty of Medicine, HKU

BCHM3701&3801 – Introduction to Chinese Medicine and Nursing
TCM Nursing Care of Common
Diseases (2)
Lixing Lao (勞力行)
Director and Professor
School of Chinese Medicine
The University of Hong Kong
November 18, 2014
Overview

TCM for common diseases/conditions (Cont.):
Postpartum Care （产后护理）, Persistent flow of the
lochia (惡露不止), Oligogalactia (缺乳), Pain management
(疼痛護理），cancer care (癌症護理）

TCM emotion-improving therapies
TCM exercise therapy

Fumigating and bathing therapy

Clinical Evidence of TCM therapies

8. Postpartum Care （产后护
理）
 Postpartum period: 6-week period after the birth
 Sweating and bleeding during delivery
 Yin-blood depleted suddenly, Yang Qi floating
easily (陰血驟虛, 陽氣易浮)
 Immune function decrease
Life style
 During postpartum period, exterior is deficient and insecure, the body can
be easily invaded by pathogenic wind
 should not face the wind when sitting or sleeping, keep away from the
wind and cold,
 Adequate rest and sleep to prevent persistent flow of the lochia and
uterine prolapse
 Avoid raw/ cold/ indulgence (生冷) in a richly fatty and sweet diet (肥甘) to
prevent spleen-stomach from damage. Digestive function is important for
the transformation of milk.
 Regulate the emotions and will (調和情志) to prevent abdominal pain and
oligogalactia (缺乳) due to stagnation of Qi and blood (氣結血滯)
9. Persistent flow of the lochia
(惡露不止)
 abnormally prolonged virginal discharge for more
than 3 weeks after childbirth
Classification
 Excessive types (實證)
 Blood stasis
syndrome (血瘀)
 Blood heat
syndrome (血熱)
 Deficient types (虛證)
 Qi deficiency
syndrome (氣虛)
Persistent flow of the lochia (惡露不止):
Chinese herbal medicine
 Tonify Yin to clear heat, cool the blood to stop bleeding (養陰
清熱，涼血止血)
 Formula: Bao Yin Jian (保陰煎)
Herbs: Sheng Di Huang (生地黃), Shu Di Huang (熟地黃), Bai Shao (白芍) ,
Shan Yao (山藥) , Xu Duan (續斷), Huang Qin (黃芩) , Huang Bo (黃柏), Gan
Cao (甘草)
 Tonify Qi and blood, control blood to stop bleeding (補氣養
血，攝血止血)
 Formula: Bu Zhong Yi Qi Tang (補中益氣湯)
Herbs: Ren Shen (人參), Huang Qi (黃耆), Bai Zhu (白朮), Dang Gui (當歸),
Chen Pi (陳皮), Gan Cao (甘草), Chai Hu (柴胡), Sheng Ma (升麻)
 Promote blood circulation and remove blood stasis(活血化瘀)
 Formula: Sheng Hua Tang (生化湯)
Herbs: Dang Gui (當歸), Chuan Xiong (川芎), Tao Ren (桃仁), Gan Cao (甘
草), Pao Jiang (炮姜)
10. Oligogalactia (缺乳)
 deficiency of milk secretion during lactation
TCM Differentiation
 Excessive types (實證)
 Liver Qi depression
and Qi stagnation
syndrome (肝郁氣
滯)
 Deficient types (虛證)
 Qi and blood
deficiency (氣血虛弱)
Oligogalactia (缺乳)
Chinese herbal medicine
 Tonify Qi and blood to promote lactation (補氣養血通乳)
Formula：Tong Ru Dan (通乳丹)
Herbs: Ren Shen (人參), Huang Qi (黃耆), Dang Gui (當歸), Mai Dong (麥冬),
Tong Cao (通草), Jie Geng (桔梗), Pig’s feet (豬蹄)
 Soothe the liver to solve the Qi stagnation, free the
collateral vessels to promote lactation (疏肝解郁，通絡下
乳)
Formula：Xia Ru Yong Quan San (下乳湧泉散)
Herbs: Dang Gui (當歸), Bai Shao (白芍) , Chuan Xiong (川芎) , Sheng Di
Huang (生地黃), Chai Hu (柴胡), Qing Pi (青皮), Tian Hua Fen (天花粉) , Lou
Lu (漏蘆), Mu Tong (木通), Jie Geng (桔梗) , Bai Zhi (白芷), Chuan Shan Jia
(穿山甲) , Wang Bu Liu Xing (王不留行), Gan Cao (甘草)
Other treatments
 Acupuncture: Tangzhong (CV-17) 膻中, Ru Gen
(ST-18) 乳根.
Point combination (配穴): Shaoze (SI-1)少澤,
TianZong (SI-11) 天宗, Hegu (LI-4) 合谷
Blood deficiency syndrome血虛: addition of Ganshu
(BL-18) 肝俞, Geshu (BL-17) 膈俞,
Qi stagnation syndrome 氣滯: addition of Neiguan
(PC-6) 內關, Qimen (LR-14) 期門
Tangzhong (CV-17) 膻中
Shaoze (SI-1) 少澤
10. TCM Pain Management (疼痛護
理）
Bi- Syndrome （痺症）
 Pain in the joints of the limbs
Image courtesy of stockimages at FreeDigitalPhotos.net
Other Symptoms
 Other Symptom (症狀)
 Soreness ,numbness, heaviness (酸，麻，重感)
 Sign(體徵)
 Limited motion (活動受限)
 Location (病位)
 Muscles, tendons and joints (肌肉，筋，關節)
 Severe case (重證)
 Redness, swellings and a burning sensation in the joints (關節
紅、腫、燒灼感)
Introduction of Bi- Syndrome
–Common pathogenic factor
 Wind (風邪)
 Cold (寒邪)
 Damp (濕邪)
 Heat (熱邪)
TCM classification of Bi- Syndrome
痺—“閉 ”
 Excessive types (實證)
 Wandering Bisyndrome (行痹)
 Painful Bisyndrome (痛痹)
 Fixed Bi-syndrome
(着痹)
 Heat Bi-syndrome
(熱痹)
 Excessive and Deficient
types (虛實夾雜證)
 Wang Bi-syndrome
(尪痹)
 Deficient types (虛證)
 Syndrome of
deficiencies of Qi
and blood (氣血不足)
Bi- Syndrome :
Chinese herbal medicine
 Removing obstruction from the collaterals plus eliminating
wind(驅風通絡):
 Fangfeng Tang (防風湯)
 Warming up the channels to disperse cold plus
harmonizing the nutrient (温經散寒):
 Wenjing Tongbi Tang (温經通痹湯)
Bi- Syndrome :
Chinese herbal medicine
 Oozing dampness to remove obstructions from the
channels and collaterals plus strengthening the spleen (健
脾除濕通絡):
 Coix Seed Decoction (薏苡仁湯)
 Dispersing heat to relieve toxins , removing obstructions
from the collaterals, plus eliminating wind(驅風清熱通絡):
 Baihu Jia Guizhi Tang(白虎加桂枝湯).
Bi- Syndrome :
Chinese herbal medicine
 Tonifying the kidneys to disperse cold plus activating
blood circulation and freeing the collaterals
(温腎散寒，活血通絡):
 Bushen Quhan Zhiwang Tang (補腎驅寒治尪湯)
 Invigorating Qi to nourish blood, freeing the collaterals to
smooth the tendons (益氣養血，舒筋通絡):
 Qixue Bingbu Rongjin Tang (氣血並補榮筋湯)
Bi- Syndrome :
Acupuncture
 Principal points: A shi points (阿是穴)
 Additional points:

Wandering Bi-syndrome (行痹):


Painful Bi-syndrome (痛痹):


Shenshu (BL23,腎俞) , Yaoyangguan (DU3, 腰陽關)
Fixed Bi-syndrome (着痹):


Geshu (BL17,膈俞), Xuehai (SP10, 血海)
Yinlingquan (SP9, 陰陵泉), Zhusanli (ST36, 足三里)
Heat Bi-syndrome (熱痹):

Dazhui(DU14,大椎), Quchi (LI11, 曲池)
Bi- Syndrome :
Food therapies
 Coix Seed congee(薏苡仁粥):
 Coix Seed(薏苡仁)50g, Rice (梗米)50g
 Wu Jia Pi wine(五加皮酒):
 Wu Jia Pi (五加皮)60g, Glutinous rice(糯米)100g，
Brewer’s yeast(酒曲) some
Epigastric pain (胃痛)
Disease of spleen, stomach and intestines
~ Epigastric pain
 Epigastric pain (胃痛)
 Abdominal pain (腹痛)
 Vomiting (嘔吐)
 Dysphagia (噎膈)
 Diarrhea (泄瀉)
 Constipation (便秘)
Introduction of Epigastric pain-Core symptom
 Pain in the epigastrium, or upper abdomen of
the region close to ensiform process
Image courtesy of marin at FreeDigitalPhotos.net
Introduction of Epigastric pain -others
 Other Symptom (症狀)
 Nausea
 Epigastric fullness
 Belching
 Abnormal defecation
TCM classification of Epigastric pain
 Excessive types (實證)
 Attach of the stomach by pathogenic cold
(寒邪犯胃)
 Retention of food (飲食積滯)
 Attach of the stomach by stagnant liver Qi
(肝氣犯胃)
 Retention of heat in the liver and stomach
(肝胃鬱熱)
 Retention of blood stasis (瘀血停滯)
 Blocking the middle by dampness-heat
(中焦濕熱)
TCM classification of Epigastric pain
 Deficient types (虛證)
 Yin deficiency of the stomach (胃陰虧虛)
 Deficient cold of the spleen and stomach
(脾胃虛寒)
Epigastric pain :
Chinese herbal medicine
 Warming up the stomach to disperse cold, regulating Qi to
relieve pain(温胃散寒，理氣止痛):
 Liangfu Wan (良附丸)
 Promoting digestion to eliminate stagnation, harmonizing
the stomach to relieve pain (消滯和胃止痛):
 Baohe Wan (保和丸)
Epigastric pain :
Acupuncture
 Principal points:
 Zhongwan (RN12,中脘)
 Neiguan (PC6,內關)
 Zhusanli (ST36, 足三里)
Dysmenorrhea(痛經)
Introduction of Dysmenorrhea -Core symptom
 Periodic pain in the abdomen before, during or
after menstruation
Image courtesy of Ohmega1982 at FreeDigitalPhotos.net
TCM classification of Dysmenorrhea
 Excessive types (實證)  Deficient types (虛證)
 Syndrome of
 Qi Stagnation and
deficiencies of Qi and
Blood Stasis
blood
(氣滯血瘀)
(氣血虛弱)
 Cold evil congeals
 Deficiency of Kidney-Qi
blood
(腎氣虧損)
(寒凝血瘀)
 Damp, heat and
blood Stasis
(濕熱瘀阻)
Dysmenorrhea :
Chinese herbal medicine
 Regulating Qi and removing blood stasis to relieve pain
(理氣行滯，化瘀止痛):
 Geixia Zhuyu Tang (膈下逐瘀湯)
 Warming up the collaterals to disperse cold, removing
blood stasis to relieve pain (温經散寒，化瘀止痛):
 Wen Jing Tang (温經湯)
 Shaofu Zhuyu Tang (少腹逐瘀湯)
Dysmenorrhea :
Acupuncture
 Principal points:
 Zhongji (RN3, 中極)
 Chilao (BL32, 次髎)
 Sanyinjiao (SP6, 三陰交)
Dysmenorrhea :
Food therapies
 Cinnamon hawthorn decoction(桂皮山楂飲):
 Hawthorn(山楂肉)10g, Cinnamon(桂皮)7g, Brown
sugar(紅糖)50g
 Drink before menstruation
 Jiucai juice(韭菜汁):
 Fresh Jiucai juice(鮮韭菜汁)50g, Brown sugar(紅糖)
some
11. TCM Cancer Palliative care
Palliative care is comfort care given to a patient
who has a serious or life-threatening disease,
such as cancer, from the time of diagnosis and
throughout the course of illness.
http://www.cancer.gov/cancertopics/factsheet/Support/palliative-care
TCM Cancer Palliative care
Goal:
• Prevent or treat, as early as possible, the
symptoms and side effects of the disease and its
treatment, in addition to the related psychological,
social, and spiritual problems.
• The goal is not to cure.
• Palliative care is also called comfort care,
supportive care, and symptom management.
Role of Chinese Medicine
 Most cancer patients use CAM with the hope of boosting the
immune system, relieving pain, and controlling side effects related
to disease or treatment.
Patrick J. Mansky, Dawn B. Wallerstedt. Complementary Medicine in Palliative Care and Cancer Symptom
Management Cancer Journal:2006;12(5):425–431
CM can help you to cope with your cancer treatment by:
 Improving your quality of life.
 Improving your general health and well-being.
 Giving you a sense of control during your cancer experience.
 Helping control anxiety, stress, insomnia, and depression.
 Helping reduce symptoms of cancer and side-effects of
chemotherapy or radiation treatment, for example, pain, nausea,
loss of appetite, breathlessness, constipation, diarrhoea, or fatigue.
Common classification of CM
syndrome
 Differentiated by symptoms and side effects related
to cancer treatment (radiotherapy, chemotherapy
and surgery)
 Deficiency of Qi and Yin (氣陰兩虛)
 Deficiency of Qi and blood (氣血虧虛)
 Qi deficiency and blood stasis (气虚血瘀)
 retained dampness and heat toxin (濕熱毒蘊)
 ……
Chinese Herbal Formulas
 Deficiency of Qi and Yin (氣陰兩虛)
 Commonly seen in radiotherapy and chemotherapy
 Shengmai San (生脈散)
 Deficiency of Qi and blood (氣血虧虛)
 Commonly seen in cancer surgery
 Shi Quan Da Bu Wan (十全大补丸)
 Qi deficiency and blood stasis (气虚血瘀)
 Commonly seen in cancer post operation
 Buyang Huanwu Tang (补阳还五汤)
 Retained dampness and heat toxin (濕熱毒蘊)
 Commonly seen in cancer post operation
 Huanglian Jiedu Tang (黃連解毒湯) and Shenling Baizhu San
(参苓白术散)
Acupuncture for Cancer Care
 Diarrhea
 Shangjuxu (ST37, 上巨虛)
 Nausea and vomiting
 Neiguan (PC6, 內關)
 Headache
 Hegu (LI4, 合谷)
 Fever
 Dazui (GV14) and Hegu (LI4)
 Stomach ache
 Zhusanli (ST36) and Zhongwan (Ren12)
Dietary therapy
 Monkey-head Mushroom, American Ginseng and Pork Soup (猴
頭菇西洋參豬肉湯)
 Symptoms: Weakness, fatigue, insomnia due to cancer
treatment/operation
 Therapeutic Effects: Clear heat and toxins, prevent and treat
cancer.
 Ingredients:
 Monkey-head mushroom 猴頭菇 -100gm
 Pork-240gm
 American ginseng 花旗參 – 30gm
 Dried lungan fruit (long yan rou) 龍眼肉 -10gm
Acupuncture/TCM and Pain Management
— Current Evidence
What is Evidence-based Medicine?
何謂循證醫學？
“Evidence-based medicine is the conscientious, explicit and
judicious use of current best evidence in making decisions about
the care of individual patients.”
“循證醫學是用一種負責的、明確的和理智的方法來
採用現有最好的證據來制定對個體病人的治療方
案。”
Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS:
Evidence based medicine: what it is and what it isn’t. BMJ 1996;312:71-2.
Type and Strength of
Efficacy Evidence
有效證據的
強度和類型
針對多項
RCT 系統評價
Systematic
Review of RCTs
RCT隨機對照試驗
Strong evidence
說服力強的證據
非隨機試驗設計
Other non-randomized, trial designs
設計良好的臨床觀察
Evidence
證據
Well-designed, non-experimental studies
權威的觀點，專家委員會的報告
Opinions of respected authorities
Reports of expert committees
H J McQuay, R A Moore Evidence-based Research for Pain Relief
RCT----Randomized Clinical Trial 隨機對照臨床試驗
Opinion
觀點
系統評價和綜合分析
Systematic Reviews and Meta-Analysis
 系統評價獲取所有可得證據，根據科學價值對
其進行分類，做出總結性評價。
 Systematic review takes all the available evidence,
categorizes it by how scientifically sound it is, and then
makes summary statements
 綜合分析（薈萃分析）可以是系統評價的一部
分，但不是必須的。
 Meta-analysis may be, but is not necessarily, used as part
of the process
Large Acupuncture Clinical Trials
Published in Recent Years
近年來發表的大樣本的
針灸臨床試驗舉例
Effectiveness of Acupuncture as Adjunctive Therapy in
Osteoarthritis of the Knee: A Randomized Trial
Berman, Lao, et al. Ann Intern Med. 2004;141(12):901-10
針刺對膝關節炎療效的盲法隨機對照研究
Study Objective
To determine whether traditional Chinese acupuncture (TCA) provides greater
pain relief and improvement in function than sham acupuncture (SA) or education
for patients with osteoarthritis of the knee.
研究目的
確定傳統的針刺方法對骨關節炎病人的疼痛和功能是
否優於假針刺組（安慰劑對照）或者教育組
Study Design 研究設計
 Three arm parallel design: (N = 570)
 三組平行設計：（N=570)
1) Real acupuncture 針刺組
2) Sham acupuncture control 假針刺安慰劑對照
3) Attention / education control group 教育組
 Multi-sites 多中心
 Patients randomized by computer 電腦隨機
 Outcomes assessor blinded to group assignment
結果評估人員盲于分組情況
Five local points:
Yanglinquan GB34,
Yinlinquan SP9, Zhusanli
ST36. Dubi ST35, and
Xiyan
膝眼
犢鼻
陰陵泉
足三里
5處近處選穴
陽陵泉、陰陵泉
、足三里、犢鼻
、膝眼
三陰交
太溪
Four distal points:
Kunlun UB60,
Xuanzhong GB39,
Sanyinjiao SP6 and Taixi
Kid3
陽陵泉
4處遠處選穴
崑崙、懸鐘、三
陰交、太溪
崑崙
懸鐘
Acupuncture Treatment 針灸治療組
Outcome Measures 療效評價方法
 Primary 主要評價指標
 WOMAC Osteoarthritis Index WOMAC 骨關節炎指數
 Pain and Function subscales 疼痛和功能量表
 Secondary 次要評價指標




Patient global assessment 病人整體情況評估
MOS SF-36 健康调查简表SF-36
Six-minute walk distance 6 分鐘行走情況
Adverse events 不良反應
Results 結果
疼痛指標
WOMAC Pain Score
10
Sham
True
Education
WOMAC Pain Score
9
8
7
6
5
*
4
0
0
0
4
4
4
8
8
8
14
12
Weeks14
16
20
26
24
26
*
28
P=.003 vs SA
Results 結果
功能指標
WOMAC Function Score
WOMAC Function Score
36
Sham
True
Education
34
32
30
28
26
24
22
20
18
16
0
0
4
4
8
*
8
12
14
Weeks
*
16
20
24
26
P=.009 vs SA
28
*
German Randomized Acupuncture Trial
for Chronic Shoulder Pain (GRASP) –
德國隨機對照研究治療慢性肩部疼痛
A pragmatic, controlled, patient-blinded, multi-centre trial in an outpatient care environment
一個實用的，對照的，盲法的，多中心的，門診病人的臨床研究
Molsberger, Schneider，et al. Pain. 2010;151(1):146-54.
Study Objective 研究目的
To determine whether traditional Chinese acupuncture (TCA) is an
effective alternative to conventional orthopaedic treatment for
chronic shoulder pain
確定針灸是否能有效地治療肩部疼痛
Study Design 研究設計

Three arm parallel design: (N = 424)

三組平行設計
1)
Real acupuncture (n=154) 針刺組154例
假針刺對照組135例
3）Conventional orthopaedic therapy group (n=135) 傳統外科治療組135例
2)
Insertion Sham Acupuncture control (n=135)

Multi-center 多中心

Patients randomized by computer 電腦隨機分組
Patients were blinded to the type of acupuncture

病人針灸分組施以盲法
Intervention 治療
 Acupuncture group
針刺組
 15 treatments of Chinese acupuncture 15次針灸治療
(one to three per week, 6 weeks, each lasting for 20 min)
 local and distal points according to the channel and the individual location of the
pain 根據經絡和疼痛位置遠近取穴
 Sham group
假針刺組
 15 treatments of sham acupuncture 15次假針刺
(one to three per week, 6 weeks, each lasting for 20 min)
 non-acupuncture points, shallow puncture 非穴位、淺刺
 COT group
外科治療組
 50 mg diclofenac daily雙氯芬酸，每天50mg
 selected from physiotherapy, physical exercise,
heat or cold therapy, ultra-sonic treatment and TENS. 選擇性理療、功能鍛
煉、熱或冷療法，經皮電刺激
Acupoints
Yunmen ( LU 2) 雲門
Sham points
Jianliao ( SJ 14 )
Jianyu ( LI 15 )
肩髎
肩俞
●
Jianzhen ( SI
●
9)
肩貞
Naohui ( SJ
13 )
Binao ( LI 14 )
臂臑
臑会
Sham-point
Quchi ( LI 11 )
假穴位
Selecting of acupoint
in Acup group
針灸取穴
取一至三個阿是
穴，經絡近端取
穴（如左側所
示），遠端取穴
如條口、陽陵
泉、飛揚穴
One to three locus
dolendi (Ahshi) points
曲池
Waiguan ( SJ 5 )
外關
Hegu ( LI 4 )
合谷
Local and distal points
according to the channel
and the individual location
of the pain: ventral– Lung
1, 2; ventrolateral – Large
Intestine 4, 11, 14, 15;
lateral – Sanjiao 5, 13, 14;
dorsal – Small Intestine 3,
9
Additionally distal points
on the homolateral leg
could be selected
from Stomach 38,
Gallbladder 34, Bladder 58
Results: primary and secondary endpoints
結果：主要和次要觀察指標
VAS疼痛量表減輕50%以上的人數百分比
≥ 50% Pain
Reduction(%)(%)
Percentage of patients with a reduction of at least 50% from the
base line of VAS
70
60
50
40
30
20
10
0
*
Directly （ITT analysis）
即時效果
*
3 Month （ITT analysis）
3個月後療效
* P< 0.001 as compared to sham and COT
Acup
Sham
COT
Acupuncture for depression during
pregnancy: a randomized controlled trial
Manber, Schnyer, et al. Obstetrics & Gynecology. 2010; 115(3):
511-520
Design:
Sample size: N = 150
Interventions: 1) acupuncture specific for depression (8 wks)
2) acupuncture not specific for depression (control)
3) prenatal massage
Outcome measures: Hamilton Rating Scale for Depression
Randomization: Blocked randomization
Blinding: Patients, treating acupuncturists and raters were blinded to
the type of acupuncture
Results
Change in Hamilton Rating
Scale for Depression 17-item
scores
Change in depression severity with treatment
0
Massage
-2
-4
Control Acup
-6
Specific Acup
-8
-10
☆
-12
Baseline
☆
Week 4
Week 8
P<0.05 compared to non-specific acupuncture control
Evidence Map of Acupuncture
January, 2014
Hempel et al. VAESP Project #05-226; 2013
Evidence-based Synthesis Program
(ESP)
U.S. Department of Veterans Affairs
• In three VA (Department of Veterans Affairs)
priority areas:
Pain (N=65)
Wellness (N=44)
Mental health (N=20)
Other (N=48)
AE (N=6)
Hempel et al. Evidence Map of Acupuncture. VAESP Project #05226; 2013
Pain-related
indications
證明無效
證據不明確
可能有療效
有療效
Hempel et al. Evidence
Map of Acupuncture.
VAESP Project #05-226;
2013
肥胖
Wellnessrelated
indications
Hempel et al. Evidence
Map of Acupuncture.
VAESP Project #05-226;
2013
Evidence of no effect
證明無效
Unclear evidence
證據不明確
可能有療效
Evidence of a potential
positive effect
有療效
Evidence of a
positive effect
Mental healthrelated indications
證明無效
證據不明確
可能有療效
有療效
Hempel et al. Evidence
Map of Acupuncture.
VAESP Project #05-226;
2013
Effects of Tai chi/Qigong on Pain
Management
IF=3.73
•
•
•
•
7 RCTs
348 patients
Hip/knee OA
Intervention (Tai Chi or Tai Chi/Qigong)
Complementary and alternative exercise
for fibromyalgia: a meta-analysis
Mist SD et al. J Pain Res (IF=2.24). 2013; 6: 247–260
Included studies: 16
Outcome measurement: FIQ total score or
FIQ Pain Score
Intervention: tai chi, qigong or yoga
Favors Qigong
Favors Taichi
Favors Yoga
Conclusion:
The level of research has been moderately weak to date, but most studies
report a medium-to-high effect size in pain reduction.
Given the lack of adverse events, there is little risk in recommending these
modalities as a critical component in a multimodal treatment plan, which is
often required for fibromyalgia management.
A Randomized Trial of Tai Chi for Fibromyalgia
Wang C. et al. N Engl J Med (IF=51.658) 2010; 363:743-754
Design: Randomized controlled trial
Intervention (12 weeks):
1) Tai chi group (n=33)
2) Control intervention group (wellness education
and stretching, n=33)
Assessments: baseline, 12 and 24 weeks
Outcome measurements:
Primary: Fibromyalgia Impact Questionnaire (FIQ) score
Secondary: SF-36
12 weeks
Control
Tai Chi
p-value
FIQ score
−27.8
>>>
−9.4
<0.001
Patient’s global
assessment score
−2.5
>>
−0.6
0.002
Physician’s global
assessment score
−1.0
>
0.02
0.02
PSQI score
−3.6
>>
−0.7
0.001
60.6
>>
16.3
0.007
Physical component
8.5
>>
1.4
0.001
Mental component
7.7
>
1.6
0.03
6Minute walk test
SF36 score
24 weeks
Control
Tai Chi
p-value
FIQ score
−28.6
>>>
−10.2
<0.001
Patient’s global
assessment score
−2.4
>>
−0.7
0.001
Physician’s global
assessment score
−0.5
>
0.6
0.02
PSQI score
−4.2
>>
−1.2
0.007
49.8
=
23.2
0.12
Physical component
8.4
>>
1.5
0.001
Mental component
8.5
>>
1.2
0.009
6Minute walk test
SF36 score
Conclusion:
Tai chi may be a useful treatment for fibromyalgia and
merits long-term study in larger study populations
Further reading
 Guo-Shiou Liao, Maria Karmella Apaya, and Lie-Fen Shyur. Herbal Medicine
and Acupuncture for Breast Cancer Palliative Care and Adjuvant
Therapy.eCAM, Volume 2013 (2013), Article ID 437948,
http://dx.doi.org/10.1155/2013/437948
References

(2004). Traditional Chinese internal medicine. Beijing, Beijing : China Press of Traditional Chinese
medicine.

(2004). Zhong yi shi liao xue. Beijing Shi, Beijing Shi : Zhongguo Zhong yi yao chu ban she
北京市 : 中国中医药出版社.

(2006). Zhong yi yao shan xue. Beijing Shi, Beijing Shi : Ren min wei sheng chu ban she
北京市 : 人民卫生出版社.

(2009). Essentials of Chinese medicine. Z. Liu and L. Liu. London, London : Springer.

(2009). Zhong yi ying yang zhi liao xue. Beijing, Beijing : Ren min wei sheng chu ban she
北京 : 人民卫生出版社.

Xie, Z. (2010). Contemporary introduction to Chinese medicine : in comparison with Western medicine.
Beijing, Beijing : Foreign Languages Press.