| (1) Research purposesBecause of its unique and wide-range efficacy, acupuncture therapy is becoming an indispensable means in modern clinical treatments. However, acupuncture is a practical therapy with some risks, and may lead to some accidents. In recent years, acupuncture accidents and its side effects have gradually being paid attention, evaluation methods of acupuncture safety are becoming hot and difficult spots in Chinese and foreign medical research. Nowadays, existing studies are mostly focusing on analyses on acupuncture accidents reported in literatures, and discussion on levels of acupuncture safety. Nevertheless, it lacks analyses and summarization of fundamental reasons of acupuncture accidents, as well as theoretical and systematical investigation on the relationship between accidents and safety in acupuncture therapy. Therefore, theoretical studies of acupuncture safety should be strengthened.(2) Research methodsResearch methods in this paper include collection, organization and analyses of literature as well as modeling. Literature is collected by manual access to libraries, looking up online digital databases, such as CNKI, VIP, MEDLINE and so on. Data from literature are analyzed by using both vertical and horizontal methods. By using content analysis, comparitive methds and positive law, constitutive factors of acupuncture safety and their internal connections are found, so that the essence of acupuncture safety and laws governing the operation are summed up. On this basis, the corresponding theoretical model of acupuncture safety is inferred, and further validated.(3) Results Based on the unity of opposites between the acupuncture safety and accidents, from the philological point of view, the ancient and modern literature on acupuncture accidents from China and foreign countries is collected, analyzed and summed up. As a result, it indicates that in ancient times, the thought about acupuncture safety is originated in "Huangdi Neijing", and, nevertheless, scattered throughout various chapters. Nowadays, with the development of a variety of practice standards, means of diagnosis and treatment and clinical experience, acupuncture practitioners and researchers begin to study acupuncture safety. Most of these studies are derived from clinical experience, and lack of systematic summarization and theoretical guidance.Reasons of accupuncture accidents in clinical treamts are complex and diverse. They mainly involve six factors, i.e., practitioners, patients, needles, time and environment. In this work, we only consider one period of acupuncture treatment, typically, duration of which is 30-60 minutes or shorter, and environment of which is indoor and stable. Therefore, here we assume that time and environment are constant, practitioners, patients and needles are variables. As a result, the origianl model of acupuncture treatment is simplied to interactions among practitioners, patients and needles, in which practitioners and patients are subjects, and needles are the media between subjects. Interactions among the practitioner, the patient and the needles run through the whole process of acupuncture treatment. By analyzing interactions among these three factors, it suggests that realization of acupuncture safety is the result of interactions between the practitioner, the patient and the needles, but not only one factor. These interactions are related to attributes and behaviours of these three factors. Based on the proposed theoretical model of acupuncture safety, we further propose a theoretical framework of acupuncture safety.In the proposed theoretical framework of acupuncture safety, safety attributes of the practitioner involve awareness, state of mind and skills. Safety awareness of a practitioner refers to the subjective self-protection awareness of the practitioner formed under circumstances that he/she comprehensively understands adverse effects of acupucture accidents. It is the premise for a practitioner to learn safety skills, produce safety states of mind, and control safety behaviours. For example, the practitioner must have a sense of sterility so as to disinfect very well in clinical treatments for avoiding infection during the acupuncture treatment. The safety state of mind of a practitioner refers to the psychological status of the practitioner during a clinical treatment. It directly determines safety behaviors of the practitioner, and reilects the adaptability of the practitioner's safety awareness and skills to the changing safety status during a clinical treatment. For example, in case of accidents, the practitioner should keep calm and high responsibility. Safety skills of a practitioner are the technical capability of the practitioner to prevent and control occurrence and development of acupuncture accidents during a clinical treatment. They are the technical support of a practitioner's safety awareness and behaviours. For example, the practitioner must master knowledge of anatomy and so on. Safety behavoiours of a practitioner are behaviours of the practitioner with safety awareness, state of mind and skills so as to minimize adverse effects of possible acupuncture accidents during a clinical treatment. These behaviours are applied by the practitioner to the patient and the needles. They are determinants for realizing safe consequence. Therefore, in the proposed theoretical framework, from the practitioner's point of view, acupuncture safety is realized by a sequence of safety behaviours applied by the practitioner with safety attitudes, such as awareness, state of mind and skills.Similarly, in the proposed framework, a patient has safety attitudes and behaviours. Safety attitudes of a patient usually involve such a subjective attitude as safety state of mind, that is the psychological status of the patient during a clinical treatment. Safety behaviours of a patient are behaviours of the patient with safety state of mind to minimize adverse effects of acupuncture accidents during a clinical treatment. It usually embodies the degree that the patient coordinates with the practitioner. Therefore, from the patient's point of view, acupuncture safety is realized by a sequence of safety behaviours applied by the patient with safety attitudes.Since the filiform needle is the most widely applied kind of needles in acupuncture clinical treatments, the needles considered in this work are filiform needles. In the proposed framework, needles possess safety attitudes, which mainly refer to the safety requirements, such as quality, thickness and length.In short, in the proposed theoretical framework, especially, the proposed theoretical model of acupuncture safety, attitudes and interactions among various factors are systemactically described. The proposed framework and model have high generality and openness. Thereafer, based on this framework and model, we will analyze existing clinical cases, systematically summarize the operation standards followed by practitioners in their practice. Later, the inheritance relationship between the proposed framework and "Huangdi Neijing" is studied. Some basic ideas about acupuncture accidents and safety derived from the proposed framework are described in "Huangdi Neijing", but scattered in various chapters. By applying factors of acupuncture safety proposed in the framework in cases described in "Huangdi Neijing", the insight and understanding of the proposed framework is deepen further.Next, we discuss the relationship between acupuncture safety and needling depth. Needling safety depth is proposed as an application of the proposed framework to needling depth. Needling safety depth refers to the maximum needling depth ensuring acupuncture safety. Needling safety depth is usually obtained by the dangerous needling depth multiplying a positive coefficient of less than 1. The needling safety depth is applied to prevent from needling too deeply, that is to say, the needling safety depth is the needling depth that keeps both acupuncture efficacy and safety. Hence, the practitioner should achieve efficacy under circumstances that guarantee acupuncture safety.(4) ConclusionBy collecting and summarizing ancient and modern acupuncture research, the literature origin of acupuncture safety theory is studied. Based on the systematic study of acupuncture accidents and safety, five factors leading to acupuncture accidents are proposed. These five factors are practitioners, patients, needles, time and environment. By studying their attitudes and interactions, a theoretical framework of acupuncture safety is proposed. Furthermore, by applying this framework to practice, needling safety depth is proposed. In summary, the theoretical framework of acupuncture safety is proposed to provide guiding clues and ideas for reducing acupuncture accidents, setting up clinical operation standards of acupuncture safety, improving needles, and clutivating high-quality practitioners.
|
PDF Full Text Request