Systematic Review Of Clinical Effect Of Acupuncture For Vertigo With Excess Syndrome Based On Evidence-based Medicine

Objective To collect all published study at home and abroad before June2012, about acupuncture treatment of vertigo with excess syndrome randomized controlled in English and Chinese RCT. Using the method of evidence-based medicine, to evaluate acupuncture treatment of primary efficacy and safety of vertigo with excess syndrome systematically. So as to provide evidence for acupuncture treatment of vertigo with excess syndrome in the clinical application.Materials and Methods Make inclusion and exclusion criteria strictly, using the method of combining the computer retrieval and manual retrieval.8Databases including Cochrane Library (2012Issuel), PubMed or Medline(1980-2012), Embase disc(1978-2012), Ovid Evidence-based medicine databases (Cochrane DSR, ACP Journal Club, DARE, and CCTR.1991-2012), CNKI (China National Knowledge Infrastructure)(1994-2012), CBMdisc (China Biomedicine Database disc)(1978-2012), Wan-fang (a full text issues database of China)(1975-2012) and VIP(1959-2012)were searched in combination with hand searching for5relevant journals which including "Chinese Acupuncture","Shanghai Journal Of Acupuncture","Journal Of Clinical Acupuncture","Acupuncture Research","Shanghai Journal of Traditional Chinese Medicine" published in ten years recently from2003to2012, and in http://www.google.hk, http://www.controlled-trials.com, http://www.clinical trials.gov to supplement search. Then make data extraction and quality assessment by two researchers independently in accordance with the inclusion criteria of randomized controlled trials, if met any differences through discussion solve it by the researcher. Finally, do quality assessment and material synthesis for the study which were into the research. Use the number of patients valid and invalid as the indicators of the efficacy of acupuncture treatment of vertigo with excess syndrome. Statistical analysis provided by Cochrane Collaboration RevMan5.1software, count data, calculate the odds ratio (OR) or relative risk (RR) and95%confidence interval (CI); measurement data, weighted mean difference (WMD) or standardized mean difference (SMD) and95%confidence interval. Use the x2test to determine the heterogeneity between the studies, P≤0.1, we think the difference have statistical significance. If there were no statistical heterogeneity between the studies, we use the fixed effect model combined with analysis. Or, use the random effect model combined with analysis, and then analysis the source of the heterogeneity.Results A total of153retrieved documents, which, by reading the title and abstract screening, remove56studies which not related with the research.45studies which not related with the research and32studies which were repeat published were removed by reading the full text.4studies were removed which make acupuncture treatment as the controlled group. Ultimately, there were16RCT studies include1267cases into the systematic review, and they are all Chinese. Use the method provided by Cochrane evaluation member manual5.1and the internationally recognized CONSORT (Consolidated Standards for Reporting of Trials) statement and STRICTA (Standards for Reporting Interventions in Controlled Trials of Acupuncture) to report the quality evaluation. We find the quality of the studies were low. Do Meta analysis or descriptive analysis after data retrieved. Most of the into-studies were used the effective rate to illustrate the curative effect, only1articles used vertigo symptoms and functional score to illustrate. Meta analysis shows:the acupuncture was superior to western medicine alone [M-H OR4.84,95%CI(2.39,9.81), P<0.0001]; acupuncture combined with Chinese traditional medicine is better than that of traditional Chinese medicine alone [M-H OR3.82,95%CI(2.06,7.10), P<0.0001]; acupuncture combined with Chinese traditional medicine is better than that of western medicine alone [M-H OR3.14,95%CI(1.81,5.45), P<0.01]. In the aspect of vertigo symptoms and function scores, in one test taken PingHengZhen combined with traditional Chinese medicine controlled with traditional Chinese medicine. The results shows:in the third day of treatment,[MD4.66,95%CI(2.97,6.35)], in the seventh day of treatment,[MD0.95,95%CI(0.03,1.86)], in the fourteenth day of treatment,[MD0.89,95%CI(0.71,2.49)]. The third treatment and the seventh day of two groups of patients with vertigo and function evaluation integral contrast have significant difference, the fourteenth day two groups of integral no significant difference. In the side of clinical treatment:Most of the into-literature use fengchi、baihui、jingjiaji as the main local acupoint, and differentiation acupoint selection according to hyperactivity of liver Yang type, sputum type, blood stasis resistance orifices type. The acupuncture technique is the use of filiform needle reducing method should be emphasized. Treatment time is generally30minutes for retaining needle,1times a day,10d for a period of treatment, a total of two period of treatment better.Conclusion①Current evidence suggests that acupuncture combined with Chinese medicine or acupuncture treatment of vertigo with excess syndrome have obvious curative effect.②Acupuncture treatment of vertigo with excess syndrome may according to liver Yang type, sputum type, blood stasis resistance orifices type three types to differentiation acupoint selection and choose local acupoint.③The acupuncture technique is the use of filiform needle reducing method should be emphasized. In general retaining the needle30minutes, once a day,10d a course of treatment, two period of treatment effect is better.④Because of the low quality of the related literature, so we should treat the result carefully. We also need design high quality of multicenter and large sample RCT research to report in the future.