Letter by Vannacci et al Regarding Article, “Randomized Trial of Acupuncture to Lower Blood Pressure”
To the Editor:
We read with much interest the article by Flachskampf et al1 on the effect of acupuncture in decreasing blood pressure in hypertensive patients. Although we appreciated the cooperation between Nanjing University in China, the regional hospital Klinikum Ottobeuren, and the Universitätsklinikum Erlangen in Germany, which offered traditional acupuncture to be administered by Chinese doctors with a high level of expertise, we noticed some inaccuracies in the text with regard to the description of acupuncture technique. In the section reporting the acupoints chosen for the treatment of hypertension, the authors state that Taiyang is a single point and thus was used monolaterally. It should be noted that Taiyang is instead bilateral, making it unclear whether, in the study protocol, treatment was applied to the point monolaterally or bilaterally. It also seems unusual to quote a text written in German2 to describe acupoint localization and nomenclature because the excellent and abundant English literature could have been used for this purpose and the German may be difficult to interpret. Thus, some uncertainty arises with the use of German abbreviations for channel names (Mp, Ma, KG, LG, etc), and for non–German-speaking readers, accurate identification in the text of the acupoints cited could have been difficult. In the search of clarity and to encourage correct interpretation of the results, we strongly suggest that the international classification of acupoints by the World Health Organization3 be used and referenced in clinical trials. Furthermore, the World Health Organization currently is conducting a campaign to address the pressing need for a common language (international standard terminology and technical terms) to be used in traditional medicine.4 In conclusion, we underline the need for the utmost accuracy in the description of acupoints (eg, monolateral versus bilateral) and for the use of universally accepted nomenclature to obtain a correct conduct and interpretation of clinical trials with acupuncture.
Flachskampf FA, Gallasch J, Gefeller O, Gan J, Mao J, Pfahlberg AB, Wortmann A, Klinghammer L, Pflederer W, Daniel WG. Randomized trial of acupuncture to lower blood pressure. Circulation. 2007; 115: 3121–3129.
Stux G, Stiller N, Pomeranz BH. Akupunktur. 5th ed. Berlin, Germany: Springer; 1999.
Standard Acupuncture Nomenclature: A Brief Explanation of 361 Classical Acupuncture Point Names and Their Multilingual Comparative List. 2nd ed. Manila: World Health Organization; 1993.
International Standard Terminologies on Traditional Medicine in the Western Pacific Region. Manila: World Health Organization; 2007.