The Study Of Acupuncture In Preventive Treatment Of Disease And Its Application And Development In Hong Kong

ObjectiveThis research is to find out the feasible strategic measures to facilitate the development of acupuncture in preventive treatment of disease in Hong Kong(HK).First,we reviewed the ideologies,history and modern clinical use of acupuncture in preventive treatment of disease.Systematic review and meta-analysis was conducted to evaluate the effectiveness and safeness of acupuncture in preventive treatment of disease.The development of traditional Chinese medicine(TCM)and acupuncture in HK was also reviewed,along with the use of acupuncture in preventive treatment of disease in HK.Through case studies,questionnaire surveys and in-depth interviews,we explored the current use of acupuncture in preventive treatment of disease in HK,and the factors that influence its promotion.Feasible measures to enhance its promotion were then proposed.MethodsThe first part is literature review.Classics and contemporary literature of TCM were reviewed using the database of CNKI and HK Public Library.Findings include the concept,ideologies and application of acupuncture in preventive treatment of disease throughout history,the relationship between preventive treatment of disease and sub-health state,pattern differentiation methods and modern clinical use of acupuncture in preventive treatment of disease.The second part is systematic review and meta-analysis.Three of the most common chronic diseases in HK were selected.Systematic review and meta-analysis was conducted to evaluate the effectiveness and safeness of acupuncture in their premorbid state,in order to provide more scientific evidence supporting the application and promotion of acupuncture in preventive treatment of disease in HK.The research method is as follow:Searched for the required randomized controlled trials literature from 9 databases,including CNKI,Wanfang,VIP,SinoMed,PubMed,Cochrane Library,Web of Science,ProQuest,Embase.The retrieval time was from the establishment of the database to June 2023.Searching keywords included the name of the diseases,intervention measures,and research types.Inclusion and Exclusion criteria were designed according to PICOS principle.Randomized controlled trials that focused on the effect of acupuncture on patients with transient ischemic attack(TIA),prehypertension,and prediabetes were included.Literature screening was performed according to the inclusion and exclusion criteria.Data extracted were then integrated using Microsoft Excel.Risk of bias was evaluated using the Cochrane risk-of-bias tool for randomized trials.Quality of the literature was evaluated using the modified Jadad scale.Data analysis was performed using ReviewManager 5.3.Funnel plots were used to evaluate publication bias.TSA v0.9.5.10 Beta software was used to conduct sequential analysis to ensure reliability of the results.The third part focuses on the development of TCM and acupuncture in HK,and also the application of acupuncture in preventive treatment of disease in HK.Database of CNKI,PubMed,Web of Science,and HK Public Library were reviewed.Reports and articles released by the government,TCM organizations and academic institutions were also reviewed.Findings include the development of TCM and acupuncture in HK,health care system in HK,health and consultation status of HK public,clinical research and services of TCM and acupuncture in preventive treatment of disease in HK.Two case studies are also conducted,including smoking cessation by acupuncture,and treament of COVID-19 by TCM.Based on the above findings,we proposed the research hypotheses.The forth part is empirical research to verify the hypotheses.To review the application and development of acupuncture in preventive treatment of disease in HK from different perspectives,three independent empirical research were conducted,including questionnaire for HK citizens,questionnaire for TCM practitioners,and in-depth interview.It is a visionary study on the cognition,application,expectation and sustainable development of acupuncture in preventive treatment of disease in HK.Both questionnaires were conducted electronically.Google Form survey management application was used to set up,input and collect responses for the questionnaires.Data collected were saved to the Excel spreadsheet for archiving.Invalid data were removed.Qualified data were used for further analysis.Questionnaire for HK citizens has 39 questions.The survey was conducted from June 20 to November 6,2022 by convenience sampling and snowball sampling methods.1185 questionnaires were collected,including 5 invalid and 1180 valid questionnaires,with an effective rate of 99.6%.Questionnaire for Chinese medicine practitioners has 34 questions.The survey was conducted from July 2 to November 21,2022 by purposive sampling and snowball sampling methods.473 questionnaires were collected,including 2 invalid and 471 valid questionnaires,with an effective rate of 99.6%.In-depth interviews are conducted in the form of semi-structured interview from mid-September to early December 2022.18 seniors and experts of TCM were invited as interviewees by purposive sampling and snowball sampling methods.Themes of interview include the popularity,strengths,weaknesses,opportunities,threats,measures,roles of different parties,and the prospects of acupuncture in preventive treatment of disease in HK.A total of 712 minutes interview recordings were converted into text records using audioto-text software,and further collated into 182000 words transcripts by the researcher.According to qualitative coding method of Grounded Theory,688 Open Coding was obtained.After further conceptualization and categorization,140 Axial Coding and 40 Selective Coding were sorted.Based on the above findings,further analysis was performed by using SWOT model and TOWS matrix analysis method.Summarizing the strengths(S),weaknesses(W),opportunities(O),threats(T),and other challenges mentioned before,we proposed four combination strategies,including SO strategy,WO strategy,ST strategy,WT strategy.Furthermore,we proposed different strategies and measures that need to be implemented preferentially and continuously,as well as the roles of different parties in the development and popularization of acupuncture in preventive treatment of disease in HK.ResultsStroke,hypertension and diabetes are three of the most common chronic diseases in HK.Early prevention,diagnosis and treatment are of great significance.Therefore,this study conducted a systematic review and meta-analysis of acupuncture in the treatment of TIA,prehypertension,and prediabetes.The results are as follow:About the effect of acupuncture on TIA,19 literatures published from 2009 to 2021 were included,involving 1372 cases.Meta-analysis results show that acupuncture intervention groups are better than control groups in the treatment of TIA.Acupuncture intervention can effectively improve total syndrome efficiency,reduce TCM syndrome score,reduce positive rate of microemboli.It can also reduce high-shear whole blood viscosity,low-shear whole blood viscosity,plasma viscosity,hematocrit,total cholesterol,triglycerides,and increase high-density lipoprotein.There is no significant difference between the effect of acupuncture intervention groups and control groups on low-density lipoprotein.Sequential analysis show that acupuncture intervention can effectively improve total syndrome efficiency in TIA,and the evidence is conclusive.About the effect of acupuncture on prehypertension,17 literatures published from 2014 to 2022 were included,involving 1307 cases.Meta-analysis results show that acupuncture intervention groups are better than control groups in the treatment of prehypertension.Acupuncture intervention can effectively improve total blood pressure effective rate,blood pressure compliance rate,and total syndrome efficiency.It can also reduce systolic and diastolic blood pressure.Sequential analysis show that acupuncture intervention can effectively improve blood pressure compliance rate in prehypertension,and the evidence is conclusive.About the effect of acupuncture on prediabetes,34 literatures published from 2010 to 2022 were included,involving 3236 cases.Meta-analysis results show that acupuncture intervention groups are better than control groups in the treatment of prediabetes.Acupuncture intervention can effectively improve the clinical effective rate,normal blood glucose conversion rate,and reduce diabetes conversion rate.It can also reduce fasting plasma glucose,2-hour plasma glucose,and glycated hemoglobin HbAlc.Sequential analysis show that acupuncture intervention can effectively reduce the diabetes conversion rate in prediabetes,and the evidence is conclusive.For the safeness of acupuncture,reports of adverse reactions in acupuncture intervention are few.There were no reports of serious accidents or sequelae,indicating that acupuncture intervention is relatively safe.Results of the three independent research were analyzed.Most of the hypotheses are supported by the research findings.The results also showed that there is a general consensus among the public and TCM practitioners regarding the application and development of acupuncture in preventive treatment of disease in HK.Results of the studies show that acupuncture in preventive treatment of disease is not popular in HK.Lack of policy support,lack of understanding,and medical cost burden are the primary constraints to its development.Lack of policy support comprises health care policy,health care system,development planning and positioning of TCM,allocation of resources for TCM,and subsidy for patients using TCM and acupuncture services.Lack of understanding includes the lack of awareness,inadequate knowledge and misunderstanding on health condition,TCM,acupuncture and preventive treatment of diseases.To facilitate the development of acupuncture in preventive treatment of disease in HK,special attention should be given to health care policy,publicity and promotion,education and research.The strengths of promoting acupuncture in preventive treatment of disease in HK are(1)Curative effect of acupuncture:Less side effects;Safeness;Convenience;Timing of treatment;Instant effect;Suitable for those who are unfit for medication;Remedy the deficiencies of medication;No drug interaction;Moxibustion,cupping,acupoint application and auriculotherapy are non-invasive therapies;Combination therapy can be used;Proven effective for some diseases;Effective for the prevention and treatment of some post COVID-19 condition;Some acupuncture therapy can be used for self-care;Extensive theoretical and practical experience.(2)Cost of acupuncture:Lower cost;Stable supply.(3)Blistering moxibustion:Well known preventive effect.(4)Quality of service:Better services and humanistic care.(5)Education and research:Educational and scientific research achievements of HK are highly accredited.(6)Support from China:Can draw on the experience of TCM specialists in mainland.On the weaknesses,(1)Risks of acupuncture:Pain and fear;Bruises and scars;Dangerous acupoints and operations are risky;Complicated treatment for skin injury.(2)Time factor:Comparatively time consuming;Timing of treatment is critical.(3)Curative effect of acupuncture:Physical constraint;Adjusting the time and method for acupuncture intervention to avoid adverse reaction may reduce the curative effect;Practitioners’ skill may affect the curative effect;Cooperation of patients is needed;Indications and roles of acupuncture in prevention strategies are unclear;Lack of standardized operation;Lack of efficacy evaluation mechanism;Lack of monitoring system and equipment for preventive treatment of disease.(4)Talents:lack of specialized practitioners;Lack of talents and resources for scientific research;Difficulties in knowledge inheritance.(5)Education and research:Lack of standardization causing difficulties in conducting research;Lack of clinical research makes it difficult to gain people’s confidence;Insufficient knowledge in modern biomedicine.On the opportunities,(1)Post COVID-19 condition:Acupuncture is effective for the prevention and treatment of some post COVID-19 condition;People have more exposure to TCM.(2)Government concerns:Regulatory system of TCM has been improved after HK reunification;Current government pay more attention to the development of TCM.(3)Chinese Medicine Hospital:It may promote the use of acupuncture in preventive treatment of disease.(4)Western medicine factors:Introducing TCM can relieve the burden on healthcare services and medical expenses;Western medicine has less opposition against acupuncture.(5)Social demand:Increasing public demand for better health;Beneficial effect of acupuncture on the aging population;Community-based organizations have more concern on public health.(6)Information technology:More channels to promote TCM;New treatment modalities,such as video diagnosis.On the threats,(1)Cognition:Lack of understanding of acupuncture and preventive treatment of disease;Lack of confidence in the curative effect of acupuncture;Misunderstanding.(2)Mindset:Acupuncture is for treatment,not for prevention;Seek help from TCM only when Western medicine cannot cure;Unfamiliar with the idea of prevention and the use of acupuncture.(3)Psychological resistance:Resistance to invasive therapy of acupuncture;Fear and resistance due to the lack of knowledge and misunderstanding;Fear and resistance caused by episodic medical incidents.(4)Medical burden:Cost for courses of acupuncture treatment is high;People with financial difficulties may not be able to afford;Feeling that acupuncture therapy has low cost performance;Insurance has limitation on TCM treatment.(5)Social environment:The protection and tolerance for TCM are far less than those for western medicine,especially in notions,propaganda and law aspect;Westernization of TCM;Environmental limitation;Difficult to approach the targeted population;Unstable social environment.(6)Medical policy:Medical system in HK has been dominated by western medicine;Development of TCM is neglected;TCM is not incorporated in the public healthcare system;Insufficient resources for TCM;Insufficient subsidy for patients to use acupuncture services;Attendance rate of non-profit-making TCM clinics is high,it is difficult for them to provide preventive treatment services;Insufficient support for private TCM clinics;Lack of professional TCM auxiliary medical support and training;Development of TCM is constrained by different interest groups;Acupuncture treatment provided by non-TCM has affected the confidence of public towards acupuncture.(7)Promotion:Insufficient propaganda and promotion;Exaggerated propaganda lead to disappointment.(8)Acupuncture technique:The use of some techniques and operations may need to be compromised.Using TOWS matrix analysis method,we concluded four combination of SO,WO,ST and WT strategies,covering 7 strategic categories and 22 measures,including post COVID-19 condition,medical policy,publicity and promotion,education and research,basic acupuncture services,medical insurance and supervision of non-TCM services.Medical policy,publicity and promotion,education and research are most significant.SO combination has the most diverse strategies and measures,making good use of strengths while striving for opportunities,will maximize the development of acupuncture in preventive treatment of disease.ConclusionsAcupuncture therapy is a method worthy of promotion and application for disease prevention and treatment.It can improve the symptoms and clinical indicators,transform the body into a healthier state.Acupuncture therapy includes acupuncture,moxibustion,cupping,medicated plaster applied to a point,auriculotherapy,etc,providing people with more treatment options in different health status.To facilitate the development of acupuncture in preventive treatment of disease in HK,the following strategies and measures should be implemented as soon as possible.Taking the opportunity of the epidemic,put forward the use of acupuncture for the treatment of post COVID-19 condition.About“medical policy”strategy,government should concern the sustainable development of TCM;An independent administration of TCM should be set up;TCM should be incorporated into the public healthcare system;More resources should be allocated to TCM;Increase the subsidy for patients to use acupuncture for diseases and preventive treatment.About“publicity and promotion”strategy,knowledge of acupuncture and preventive treatment of disease should be promoted to the public;Promote and develop plans using acupuncture in preventive treatment for specific diseases and target populations;Government should take the dominant role in publicity,leading other institutions to carry out ongoing promotion together.About“education and research”strategy,it is necessary to provide professional trainings for TCM;More clinical research should be done;Public education is needed.About“basic acupuncture service”strategy,comprehensive treatment services should be established.About“medical insurance”strategy,medical insurance coverage for TCM treatment should be expanded.In addition,the following strategies and measures also need to be implemented continuously.About“medical policy”strategy,“Supplementary Medical Professions Ordinance”should be amended to allow diagnostic imaging detection and laboratory assay referral by TCM practitioners;Induce the cooperation between TCM and other medical specialties;Establish TCM specialist clinic for preventive treatment of disease.About“publicity and promotion”strategy,educate the public with simple acupuncture therapy for self-care;Improve the reputation and recognition of TCM to enhance public confidence.About“education and research”strategy,TCM practitioners can apply biomedical research findings to clinical practice.About“basic acupuncture services”strategy,standardized treatment plan using acupuncture in preventive treatment of disease should be established.About“supervision of non-TCM services”strategy,services with the nature of TCM but provided by non-TCM must be supervised.To facilitate the development of acupuncture in preventive treatment of disease,it is necessary for the government,universities,non-profit-making and private TCM institutions to collaborate.Government should play a dominant role in policies making and implementation,resources allocation,leading publicity and promotion.Universities mainly responsible for education and training,clinical research,publicity and promotion.Nonprofit-making TCM clinics mainly provide low-cost services for the grass-roots,elderly and low-income groups,cooperate with the government to promote and provide acupuncture services in preventive treatment of disease,carry out clinical research,provide on-the-job training.Private TCM clinics provide services for everyone,cooperate with the government to promote and provide acupuncture services in preventive treatment of disease.With the collaboration of all parties,acupuncture in preventive treatment of disease in HK will be extensively used and have sustainable development.