Clinical reasoning in traditional Chinese medicine implications for clinical

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1、ClinicalreasoningintraditionalChinesemedicine:implicationsforclinicalresearchChristopherZaslawskiThediagnosticprocessesofTraditionalChineseMedicine(TCM)arefundamentaltothepracticeofacupuncture.Areviewwasconductedofsomecentralissuesunderlyingpatterndifferentiationandtheintegrationofth

2、eTCMdiagnosticsystemintoacupunctureresearch.Problemswithdiagnosticreliabilityandtheimplicationsforclinicaltrialsarediscussed.Futureresearchshouldincludediagnosticreliabilitystudiesandthedevelopmentofstrategiesforimprovingdiagnosticreliabilitywithinacupunctureclinicaltrials.ª2003Elsev

3、ierLtd.Allrightsreserved.Duringthelastfourdecadestherehasbeenin-knowledgeofthetraditionallybasedsystemsofcreasinginterestinclinicalresearchofacupunc-acupuncture(TBSA).Itisonlyinthelastdecadethatture.1–3Thishasresultedinanexpandingnumberofthissituationhasbeenchallengedwithincreasingre

4、portsbeingpublishedinscientificandprofes-numbersofTBSApractitionersbecominginterestedsionaljournalsandthecautiousacceptanceofinresearch,andsubsequentlyinvolvedinthedesignacupunctureasatherapeutictechniqueforcertainandconductofprojectsusuallyincollaborationwithconditions.4Researchinth

5、ewesterncountrieshasorthodoxresearchers.12Onecriticismthathasbeenfocusedonattemptingtoemployarigorousscien-voicedbyTBSApractitionersisthereluctancetotificapproach,ofteninvolvingrandomisationandaacknowledgetheuniqueattributesofaTBSAandtocontroltreatment.5;6Yetdespitethis,mostsystem-de

6、signappropriateclinicalresearchthatintegratesaticreviewsandmeta-analysesofacupuncturehaveaspectsofaTBSAwithinanorthodoxresearchconcludedthattherewasinsufficientevidencetomodel.13ByincludingaspectsofaTBSAwithinthedeterminetheefficacyofacupuncture,thatmostofresearchmodeltheexternal/con

7、structvalidityofthetheclinicaltrialsreviewedwereofpoorqualityandmodelwouldbeimprovedandtheoutcomesmorethatfurtherrigorousresearchwasneededtoclarifylikelytoreflectclinicalpractice.14thesituation.InresponseanumberofauthorshaveInaddition,anumberofauthorshavesuggestedCorrespondenceto:que

8、stionedtheva