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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