동양의학에서 침을 통한 치료는 오랜역사 만큼이나 그 신뢰도도 깊다.
우리나라에서는 골절 등의 큰 외상이 아닌이상 정형외과의 대안으로 한의원을 많이 찾는다.
과연 침술은 효과가 있는 것인가? 어떠한 원리로 가능한 것인가?
의학인이 아닌 일반인의 지식으로 최대한 파헤쳐 보려한다.
개인적으로 무리한 운동으로 염좌를 여러번 경험했고 그 때마다 정형외과보다는 근처에 접근성이 좋은 한의원을 자주 찾았다.
치료를 하면서 아래와 같은 나름의 의견을 갖게 됐다.
가설1 : 하루아침의 기적은 일어나지 않는다. 대부분은 위약효과이다. 장기적인 골병을 방지해주는 차원의 관리이다.
가설2 : 침의 효능이 있다면 오직 혈액 순환 촉진 때문일 것이다. 침의 위치는 그리중요하지 않다.
가설3 : 침술의 효능에 대해 한의사들도 사실은 대부분 회의적일 것이다.
좀더 객관적인 판단 근거를 찾기위해 국내 자료보다는 서양인들이 작성한 자료들을 참고해야 될 것같다.
According to WHO (World Health Organization) acupuncture is effective for treating 28 conditions, while evidence indicates it may have an effective therapeutic value for many more. People with tension headaches and/ormigraines may find acupuncture to be very effective in alleviating their symptoms,according to a study carried out at the Technical University of Munich, Germany. Another study at The University of Texas M. D. Anderson Cancer Center found that twice weekly acupuncture treatments relieve debilitating symptoms of xerostomia - severe dry mouth - among patients treated with radiation for head and neck cancer.
일단 WHO에서는 28개 그 효능을 공식적으로는 인정한 것 같다.
미국 FDA에서도 침을 더 이상 "실험용"이 아닌 일반의료기기와 동일하게 규정하고 있다.
How does acupuncture work?
Traditional Chinese medicine explains that health is the result of a harmonious balance of the complementary extremes of yinand yang of the life force known as gi or chi. Qiis said to flow through meridians (pathways) in the human body. Through 350 acupuncture points in the body, these meridians and energy flows may be accessed. Illness is said to be the consequence of an imbalance of the forces. If needles are inserted into these points with appropriate combinations it is said that the energy flow can be brought back into proper balance.
In Western societies and several other parts of the world, acupuncture is explained including concepts of neuroscience. Acupuncture points are seen by Western practitioners as places where nerves, muscles and connective tissue can be stimulated. Acupuncture practitioners say that the stimulation increases blood flow while at the same time triggering the activity of our own body's natural painkillers.
공통적으로 한의학(침술)에서는 질병은 신체의 불균형과 부조화에 의해 발생하며 침으로 이걸 바로 잡아줄 수있다는 주장을 하고있다.
역사를 살짝 짚고 넘어가면 시초는 중국에서 시작하여 한국, 일본 등 동양권을 중심으로 발달하였으며 최초 2,500년의 역사를 갖고 있다. 1972년 미국 닉슨 대통령이 중국을 방문하면서 서구권에 급속도로 전파됐다.
Acupuncture as a therapeutic intervention is widely practiced in the United States. There have been many studies of its potential usefulness. However, many of these studies provide equivocal results because of design, sample size, and other factors. The issue is further complicated by inherent difficulties in the use of appropriate controls, such as placebo and sham acupuncture groups.
However, promising results have emerged, for example, efficacy of acupuncture in adult post-operative and chemotherapy nausea andvomiting and in post-operative dental pain. There are other situations such as addiction,stroke rehabilitation, headache, menstrual cramps, tennis elbow, fibromyalgia, myofascial pain, osteoarthritis, low back pain, carpal tunnel syndrome, and asthma where acupuncture may be useful as an adjunct treatment or an acceptable alternative or be included in a comprehensive management program.
아직 객관적인 지표로 입증된 바는 없지만 그 효능에 대해서는 어느정도 인정이 되고있는 모양이다. 하지만 항목들을 일반화해보면 대부분 진통 완화에 대한 효과로 보여진다. 그렇다면 일시적으로 몸에 마비를 가져와 고통을 줄여줄 뿐 질병의 근원을 해결하기 어렵다고 볼 수도 있지 않을까?
아래 원하는 주제의 논문을 찾았다. 저자의 정보를 보니 대부분 국내 가천한의대생으로 보이는데 침의 효능에 대해 회의적으로 결론을 지었다. 얼음찜질 등의 민간요법 대비 약간 우위에 있지만 무시할만한 수준이라는 것이다.
Acupuncture for treating acute ankle sprains in adults.
Kim TH, Lee MS, Kim KH, Kang JW, Choi TY, Ernst E.
BACKGROUND:
An acute ankle sprain is a sudden-onset injury of one or more of the ankle ligaments. It is one of the most common musculoskeletal injuries in the general population as well as in athletes. In some countries, such as China and Korea, acupuncture is frequently used in the treatment of ankle sprains, either as a single treatment or a secondary intervention accompanied by standard medical treatment.
OBJECTIVES:
To assess the effects (benefits and harms) of acupuncture for the treatment of ankle sprains in adults.
...(중략)...
DATA COLLECTION AND ANALYSIS:
Two review authors independently screened the search results, assessed trial eligibility, assessed risk of bias and extracted data from the included trials. We calculated risk ratios (RRs) for dichotomous outcomes and mean differences for continuous outcomes. We conducted meta-analyses using the fixed-effect method or, where appropriate, the random-effects method, and used 95% confidence intervals (CI) throughout.
MAIN RESULTS:
We included a total of 20 heterogeneous studies (2012 participants with acute ankle sprains); three of which included more than one comparison. Seventeen trials were conducted in China. All of the studies had a high risk of bias due to lack of blinding. The results may also have been affected by selection bias, particularly as five studies were quasi-randomised controlled trials and 12 studies gave no information on their method of randomisation. Of our three prespecified primary outcomes, only cure rate was reported by the majority of studies. No study reported on patient-reported assessment of function and only one reported on adverse events (in which three participants receiving a control intervention experienced skin problems from over-the-counter Chinese herbal patches). The other 19 studies did not record or report on adverse events. We assessed the quality of evidence for cure rates as very low for all comparisons, which means we are very uncertain about the reliability of any of the estimates.The single study comparing acupuncture treatment with no treatment found acupuncture to be more effective with regard to cure rate at five days (31/31 versus 1/30; RR 20.34, 95% CI 4.27 to 96.68). Acupuncture plus another standard treatment versus that standard treatment alone was tested in eight studies; with cure rate data available for seven. Most of these studies reported higher cure rates in the acupuncture plus another standard treatment group than in the standard treatment alone group. However, while the results of an exploratory meta-analysis of cure rate data from eight trials testing acupuncture versus no acupuncture tended to favour acupuncture, the results were very inconsistent across the studies and the estimated effect was very imprecise (383/396 versus 272/355; RR 1.32, 95% CI 0.95 to 1.84; P value = 0.1; I(2) = 98%).Fourteen studies compared acupuncture with a variety of other non-surgical treatments, such as Chinese drug patches, hot and cold water, ice packs, oral Chinese herbal medicine and elastic bandage. Some studies found in favour of acupuncture, some in favour of the other treatment and some found a lack of evidence for a difference between the two interventions under test. The results of an exploratory meta-analysis of cure rate data from 11 trials testing acupuncture versus another non-surgical intervention tended to slightly favour acupuncture, but these were not statistically significant and the data were very heterogeneous (404/509 versus 416/497; RR 1.07, 95% CI 0.94 to 1.22; P value = 0.30; I(2) = 92%).
AUTHORS' CONCLUSIONS:
The currently available evidence from a very heterogeneous group of randomised and quasi-randomised controlled trials evaluating the effects of acupuncture for the treatment of acute ankle sprains does not provide reliable support for either the effectiveness or safety of acupuncture treatments, alone or in combination with other non-surgical interventions; or in comparison with other non-surgical interventions. Future rigorous randomised clinical trials with larger sample sizes will be necessary to establish robust clinical evidence concerning the effectiveness and safety of acupuncture treatment for acute ankle sprains.
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