摘要
耳穴诊治法是以耳郭为诊断施治部位的针灸疗法,具有突出的临床疗效和广泛的应用范围,是针灸微针体系中国际应用最广的一种。在国际上,耳穴出现了中国、美国、法国、美国、德国、意大利等耳穴流派。我国作为耳穴的发源地,20世纪80年代后期开始重视耳穴标准化工作,先后颁布了国家标准《耳穴名称与部位》(GB/T13734-92)、《耳穴名称与定位》(GB/T13734-2008,代替GB/T13734-92)、《针灸技术操作规范第3部分耳针》、《中医保健技术操作规范第6部分耳部保健按摩》。世界针灸学会联合会于2011年底颁布了针灸行业国际标准《耳穴名称与定位》。同时,法国也在做世界耳穴疗法命名。美国、法国、德国、意大利等国家学者针对耳穴国际标准化工作均提出了各自的方案,均有意于对耳穴标准展开竞争。
目的
本研究为形成统一的耳穴国际标准化方案提供充分的文献依据,为维护我国中医针灸耳穴在国际研究领域的主导权。
方法
通过查阅中文数据库-CNKI期刊全文数据库、中文科技期刊全文数据库VIP,关键词以耳穴或耳针,时间为1990年至2012年4月；外文数据库(pubmed和NSTL外文期刊联合目录)和德国针灸杂志DZA,关键词以auricular points或auricular acupuncture points或auriculotherapy,时间为1990年至2012年4月；收集耳穴国际会议代表提交的材料。本研究从文献角度对耳穴在国内外的研究进行了系统整理,对耳穴国际标准化推进的进程进行了系统梳理,对比历次耳穴国际标准会议文件,结合最新的研究,对耳穴国际标准化工作进行了现状分析与对策研究。
结果
耳穴是国内外研究的热点,在中国、美国、法国、德国主要体现在基础研究、临床研究,在意大利、奥地利、瑞士、西班牙、英国、荷兰、日本、独联体国家、非洲国家体现在临床研究方面,应用广泛。耳穴国际标准化工作主要分为三个阶段。第一个阶段为1982年至1990年,世界卫生组织多次组织召开相关耳穴标准化工作会议,为推动耳穴国际标准化工作作出了杰出的贡献。第二个阶段为1990年至2009年,耳穴在各国的发展,呈现百花争鸣的发展局面,可称为耳穴国际标准化工作的发展阶段,中国曾分别在1991年和2008年颁布了中国耳穴国家标准。但是,在国际层面上,中西方耳穴没有实质性的交流,科学研究成果没有实质性的共享。第三个阶段为2010年至今,世界针灸学会联合会推荐的行业标准《耳穴名称与定位》,称为中医药行业首部国际性标准,为进一步向国际标准化委员会提交国际标准奠定了坚实的基础。在充分了解耳穴在国内外的发展动态和主要学术流派和充分掌握耳穴国际标准化工作进展的基础之上,针对耳穴国际标准化工作推进遇到的问题,提出应挖掘各国方案共同点；针对分歧拿出数据说话；仍有分歧点,可以进行方案推荐。
结论
第一,世界针灸学会联合会行业国际标准《耳穴名称与定位》,体现了国际间耳穴学术知识的结晶,得到专家普遍共识,相信其对耳穴在国际范围内的学术交流与传播起到语言交流的作用,从而进一步推动耳穴的基础、临床和推广,使之成为世界人民广泛接受和认可的疗法。中外耳穴的名称与定位存有差异也存有广泛共性,明确差异,挖掘共性,积极推进耳穴国际标准化的进程。第二,在制定耳穴国际标准时,(1)要坚持五大原则(重视耳郭解剖、耳穴全面覆盖、研讨命名原则、立足实用和正确著录)。(2)需要国际耳穴领域专家建立共同语言。(3)充分挖掘共性。(4)模仿腧穴国际标准,分歧点进行方案推荐。(5)在耳穴分区达成共识的基础之上,重视临床应用,加强耳穴临床和基础特异性研究,运用国际上先进的科研方法,说明其特异性。(6)我国可以考虑接受美国Oleson建议将三角窝划分为6个分区。现行的标准中,耳甲腔为3个分区,“肺”区过大,如果将耳甲腔分为9个分区,分布成“井”字形,可以考虑在耳甲腔中的圆,即标准中的心区,分别在此区的上下左右四个位置作切线,便形成了耳甲腔9个区,以方便以后的研究标注不同具有临床实际意义的耳穴名称。这样便于在国际层面上进行沟通。
The diagnosis and treatment of auricular acupuncture points (AAP), one of the most popular therapies in micro-acupuncture system in the subject of acupuncture-moxibustion, was a therapy of acupuncture-moxibustion, which was proved to have prominent clinical therapeutical effect and extensive application scope. There were different auricular schools in China, America, France, Germany and Italy. China, the origin of AAP, started the standardization of AAP in the late1980s. China published the following standards, Nomenclature and Location of AAP (GB/T13734-92), Nomenclature and Location of AAP (GB/T13734-2008to replace the former one), Auricular acupuncture-the3rd part of The Manipulation Techniques criterion of Acupuncture-moxibustion, Health Care Massage on the Ear-The TCM Health Care Manipulation Techniques. The World Federation of Acupuncture-moxibustion Societies published her profession international standard of acupuncture-moxibustion-Nomenclature and Location of AAP. At the same time, France proposed the universal nomenclature of Auriculotherpy. Experts from America, France, Germany, Italy proposed their projects respectively, having the intention to compete for ISAAP.
Objectives:
To supply enough literature evidences for developing a unified project of ISAAP and maintain the leadership of tradional Chineses medicine, acupuncture-moxibustion and AAP in international research.
Methods:
From searching the Chinese database of CNKI and VIP, forein languages databases of pubmed and NSTL and the German Journal of Acupuncture (DZA in Germany) from the year of1990to April,2012, and from collecing the document of internation symposium of AAP, the reference was formed. The key word was "auricular points","auricular acupuncture points","ear points" or "auriculotherapy". This research sorted out systematically the development of auricular acupuncture points (AAP) home and abroad from the perspective of literature collection, clarified the process of the boost of international standardization of auricular acupuncture points (ISAAP), made an analysis of the existing condition of ISAAP and supplied countermeasures, based on comparing, contrasting the document of all previous symposium of ISAAP and integrating the latest research, in the purpose of giving enough literature evidence and making a unified plan for ISAAP. Results:
AAP was a hot field for scientific research ghome and abrod. The basic and clinical research of AAP was undertaken in China, America, France and Germany. The clinical research of AAP was done in Italy, Austria, Switzerland, Spain, England, Holland, Japan, Russian, African countries. AAP was applies extensively around the world. The process of the boost of IS AAP included three stages. Firstly, it is the period between the year1982and1990, several symposiums on ISAAP were organized by WHO, which accelerlated the course of ISAAP. Secondly, it was the time from the year of1990to2009when AAP was developed on a large scale in different countries or regions. Therefore, it could be called the development stage of ISAAP. China once published the national standard of nomenclature and location of AAP in1991and revised it and re-published in2008. However, AAP research was truly communicated internationally and the scientific achievement was not really shared internationally. The3rd stage was the phase from2010to now, the world federation of Acupuncture-Moxibustion Societies (WFAS) recommended a document ISAAP-Nomenclature and Location of AAP. It was the1st international traditional Chinese medicine standard. It provided a solid basis for ISAAP and a draft to international standard organization (ISO). The3rd part was analysis of the existing condition and countermearsure. Based on grasping the latest development of AAP home and abroad, main academic shools of AAP and the process of ISAAP and the problems of boosting the process ISAAP, it was suggested that experts needed to unearth the common points of different countries or regions, provide evidence on different ideas and list the proposal as a recommendation in the standard.
Conclusions:
1. Nomenclature and location of AAP, an ocupational international standard, published by WFAS, embodied the crystallization of AAP research home and abroad. It was recognized by experts. It was believed that it would effect as a language communication in international academic communication and dissemination of AAP, promote the fundamental research, clinical research and spread of AAP, for the purpose of being an extensively accepted therapy by the people around the world.
2. The following points were put forward to promote the process of ISAAP. Firstly, insisting on the emphasizing of auricular anatomy, wide spread, the principle of nomenclature, practical and accurate record. Secondly, a common language should be built among the international experts in the field of AAP. Thirdly, common points should be dug out completely. Fourthy, the international standard of channel points should be imitated on the different locations of AAP. Fifthly, the auricular zone should be firstly made a concensus, on which it was based, clinical application of AAP should be emphasized and the clinical and preclinical research of specificity should be improved and integrated with international advanced scientific method in order to note the specifieness of AAP. Finally, China could accept that the triangular fossa can be divided into6zones, and that cavum conchae can be divided into9zones for the reason that in the international standard published by WFAS, the lung zone was much too big. Four tagents could be made in order to make the circle (heart) be an inscribed circle, which can divide the cacvum caonchae into9sub-zones. It was easy to communicate internationally.
引文
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