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Chronic insomnia affects a significant proportion of the general population worldwide, and is associated with several serious medical conditions. From the Western scientific literature, hyper-arousal (on the cognitive- emotional, behavioral, autonomic, or central nervous system level) is a final common pathway involved in its pathogenesis. However, from a Chinese medicine (CM) perspective, it is the Heart, capitalized to denote the functional system as described in CM theory, that is the key organ involved in insomnia due to its role as the "seat of consciousness." This article explores how insomnia is understood from the CM perspective, in particular the role of the Heart, and some of the neurophysiological evidence that supports these ancient theoretical understandings. The potential role of the vagus nerve and its relationship with the (biomedical) heart and CM Heart is also examined. Finally, some of the evidence in association with mechanisms of action of acupuncture in insomnia, in particular its impact on cardiovascular variables associated with insomnia, is presented, along with findings of systematic reviews. [ABSTRACT FROM AUTHOR]

Objectives: Chinese medicine is a complex domain of theoretical and practical approaches that is being increasingly put under the research spotlight. The "Chinese Medicine in Australia"research project attempted to capture the clinical features of practitioners of Chinese medicine. Participants and Interventions: The project involved a national survey of Chinese medicine professional association members and registered practitioners in the state of Victoria, Australia (n = 655; response rate, 42%-55%) completed in 2012-2013. Design: The content and face validated survey was developed using new and previous workforce survey questions. Results: This paper reports on the workforce and practice characteristics of the survey respondents. Chinese medicine practitioners are highly educated, come from diverse backgrounds, and have chosen to practice predominantly in sole or multipractitioner private practice settings. An interest in the philosophy of Chinese medicine and previous experiences contributed to practitioners' decisions to study and practice Chinese medicine. Incorporating a variety of techniques, practitioners describe themselves as practicing predominantly Chinese acupuncture and herbal medicine. Conclusions: The results from this survey contribute to the understanding of the nature and description of Chinese medicine practice in Australia. [ABSTRACT FROM AUTHOR]

Background: Chinese medicine (CM) has its own diagnostic indicators that are used as evidence of change in a patient's condition. The majority of studies investigating efficacy of Chinese herbal medicine (CHM) have utilized biomedical diagnostic endpoints. For CM clinical diagnostic variables to be incorporated into clinical trial designs, there would need to be evidence that these diagnostic variables are reliable. Previous studies have indicated that the reliability of CM syndrome diagnosis is variable. Little information is known about where the variability stems from--the basic data collection level or the synthesis of diagnostic data, or both. No previous studies have investigated systematically the reliability of all four diagnostic methods used in the CM diagnostic process (Inquiry, Inspection, Auscultation/Olfaction, and Palpation). Objectives: The objective of this study was to assess the inter-rater reliability of data collected using the four diagnostic methods of CM in Australian patients with knee osteoarthritis (OA), in order to investigate if CM variables could be used with confidence as diagnostic endpoints in a clinical trial investigating the efficacy of a CHM in treating OA. Methods: An inter-rater reliability study was conducted as a substudy of a clinical trial investigating the treatment of knee OA with Chinese herbal medicine. Two (2) experienced CM practitioners conducted a CM examination separately, within 2 hours of each other, in 40 participants. A CM assessment form was utilized to record the diagnostic data. Cohen's κ coefficient was used as a measure of the level of agreement between 2 practitioners. Results: There was a relatively good level of agreement for Inquiry and Auscultation variables, and, in general, a low level of agreement for (visual) Inspection and Palpation variables. Conclusions: There was variation in the level of agreement between 2 practitioners on clinical information collected using the Four Diagnostic Methods of a CM examination. Some aspects of CM diagnosis appear to be reliable, while others are not. Based on these results, it was inappropriate to use CM diagnostic variables as diagnostic endpoints in the main study, which was an investigation of efficacy of CHM treatment of knee OA. [ABSTRACT FROM AUTHOR]

Background: The issue of transition from student to practitioner of Chinese medicine (CM) in Australia and other Western countries has received little formal attention. Workforce studies, while not up to date nationally in Australia, suggest that the majority of CM practitioners practice as sole practitioners or in small practices. Data from the state of Victoria suggest that a significant proportion of the CM workforce is relatively new to the profession. It is not known how many graduates successfully enter the workforce and importantly, remain in it. Objectives: An initial survey of final-year bachelor degree CM students in Australian education institutions in 2008 suggested that students felt 'somewhat' prepared for clinical practice in eight dimensions of clinical practice. The authors conducted a follow-up study to this initial one, seeking to investigate perceptions of confidence in CM graduates in various aspects of clinical practice within the first year of completing their degree. Methods: A content-validated survey based on the previous study was distributed to a subset of 30 graduates from the original study cohort who had indicated a willingness to participate in this follow-up survey. Results: There were a small number of responses ( n=12), limiting the usefulness of the quantitative questions. However, some interesting qualitative outcomes from the long-answer part of the survey support findings from the previous study that recent practitioners would like more clinical experience, as well as support in developing their business and interpersonal skills, and the option to participate in a professional mentoring arrangement. Conclusions: Results of this study suggest that both education providers and professional associations may be able to play important and complementary roles in assisting CM students to successfully transition into the workforce. If CM is to continue to develop as a profession in Australia, it will be important that more attention be given to how to assist new graduates to successfully transition into and remain in clinical practice. [ABSTRACT FROM AUTHOR]

Background: Little is known about how prepared Chinese medicine (CM) students perceive themselves to enter the workforce. Objective: The objective of this study was to investigate perceptions of preparedness for clinical practice of final-year CM students in Australia. Design: The study design consisted of a written survey focusing on eight dimensions relating to practice: Interpersonal Skills, Confidence/Coping Skills, Professional Networks, Professional Practice Management, Professional Patient Management, Prevention, Holistic Care, and Self-Directed Learning. Part 1 of the survey required participants to choose from six possible responses on how well they believe their CM course has prepared them in relation to 41 statements about aspects of practice (1 = very inadequately through to 6 = very adequately). Part 2 consisted of nine open-ended questions. Study participants: The study participants were final-year Bachelor degree CM and acupuncture students from Australian universities and privately operated educational institutions. Analysis and main outcome measures: Part 1 of survey: mean scores on the eight dimensions of practice. Part 2 of survey: transcribed responses were imported into NVivo8. Each part of the questions was analyzed and grouped into broad themes. Results: Seventy-one (71) of one hundred and seven (71/107) invited students (average age 29.4 years ± 7.4 years) participated in the survey conducted in 2008. Mean scores on eight dimensions of clinical practice were as follows: Interpersonal Skills 3.9 (±1.1), Confidence/Coping Skills 4.0 (±0.8), Professional Networks 4.2 (±0.8), Professional Practice Management 4.2 (±0.8), Professional Patient Management 4.7 (±0.7), Prevention 4.6 (±0.7), Holistic Care 4.4 (±0.7), and Self-Directed Learning 4.6 (±0.6). There was no significant difference in mean scores across gender. Responses to Part 2 indicated a range of suggestions on the strengths of educational courses and how transition to clinical practice could be facilitated. Conclusions: In general, CM students perceived themselves to be “somewhat adequately” or “adequately” prepared for various aspects of clinical practice. Survey results may help inform CM educators about how to better prepare students for entry into the workforce. [ABSTRACT FROM AUTHOR]

Background: Toyohari meridian therapy (TMT) is a Japanese system of acupuncture. Acupoint selection follows diagnosis of the primary and secondary patterns of disharmony ( sho) and disturbances in the yang channels. Pulse diagnosis and abdominal palpation diagnosis are the two main diagnostic methods used. Little is known about the reliability of pulse, abdominal, and pattern diagnosis in TMT. This is important since diagnosis of the sho determines acupoint treatment. If diagnosis is unreliable, there can be less confidence that the patient will receive optimal treatment. Objective: The objective of this study is to assess the level of agreement between two TMT practitioners on pulse diagnosis, abdominal diagnosis, and diagnosis of the primary and secondary sho. Methods: An inter-rater reliability study was conducted. Two (2) TMT practitioners separately conducted a TMT examination and completed an assessment form, choosing from a range of possible responses relating to pulse characteristics, abdominal diagnosis, and diagnosis of primary sho and secondary sho. The κ coefficient was used as a measure of inter-rater reliability of the outcome variables. Results: Sixty-two (62) Australians (22 males, 40 females) aged 20–65 years participated (mean age 49.2 ± 12.2 years). Level of agreement for pulse diagnosis was 57%, 61%, and 77% for pulse depth, speed, and strength, respectively. For abdominal diagnosis, the level of agreement for involvement of the Lung, Kidney, Spleen, and Liver abdominal regions was 58%, 53%, 35%, and 10%, respectively. The overall level of agreement on primary sho diagnosis was 48% and for secondary sho diagnosis, 44%. Conclusions: Overall, there was a reasonable level of agreement on basic pulse characteristics and on abdominal diagnosis for two of the abdominal regions. Level of agreement on primary and secondary sho diagnosis suggests room for improvement. Further studies are required in order to gain a greater understanding of the reliability of diagnosis in TMT. [ABSTRACT FROM AUTHOR]

The question of the objectivity of the clinical examination has been raised in relation to Western and non-Western medical systems. Western practitioners are often skeptical about Traditional Chinese Medicine (TCM), on the basis that its diagnostic variables and subcategories of disease appear subjective and not repeatable. We conducted a study investigating the reproducibility of individual diagnostic observations within three of the four diagnostic methods used in a TCM examination: inspection, palpation, and auscultation. Three TCM practitioners participated in the study, and examined 45 adults who had mild-to-moderate hypercholesterolemia but were otherwise healthy. Results indicated that while there are certain features of the TCM system that are highly objective and repeatable, such as detection of the presence of shen, character of breath sounds, and pulse speed, there are other features that are subjective and unreliable, such as color under the eyes and tongue body color. This poses a challenge for TCM practitioners to improve their clinical practice and demonstrates to Western medical practitioners that TCM does in part rest on a rigorous and objective empirical basis. [ABSTRACT FROM AUTHOR]

Background: In the practice of forms of traditional East Asian medicine (TEAM) such as Traditional Chinese Medicine and Japanese meridian therapy, treatment follows identification of underlying “patterns of disharmony.” However, little is known in an objective sense of the consistency or reliability of diagnosis within TEAM. This is important: If diagnosis is not reliable, there can be less confidence that optimal treatment is received. TEAM systems have their own diagnostic endpoints that are used as evidence of change. If these are to be incorporated into clinical studies, a prerequisite is that they are reliable. Few studies have assessed the reliability of diagnostic data collected during a TEAM examination. The majority have investigated reliability of pulse diagnosis, with results ranging from low to a very good level of agreement. Studies of reliability of tongue diagnosis and other diagnostic data collected in a Chinese Medicine examination suggest considerable variability. In general, studies of reliability of pattern diagnosis and treatment in a range of disorders have not found a high level of reliability. A range of factors may affect reliability. Objectives: This paper reviews the current knowledge of reliability of TEAM diagnoses, including limitations of studies, and discusses the implications for practice and research and how to improve the current situation. [ABSTRACT FROM AUTHOR]

Background: Chinese medicine distinguishes itself from Western medicine in the differentiation of diseases according to underlying patterns of disharmony, or Chinese medicine (CM) syndromes. CM has its own clinical endpoints that are used as evidence of change in the body. Yet, relatively little is known about the reliability of CM diagnostic techniques, the final diagnosis of a CM syndrome, or the organizing principles used to reach a CM diagnosis such as the Eight Guiding Principles. Information about reliability of CM diagnosis has important implications for clinical practice and research, particularly if CM diagnostic variables or CM syndromes are to be incorporated into study designs. Design: An inter-rater reliability study was conducted with three CM practitioners to investigate the reproducibility of CM diagnosis according to the Eight Guiding Principles and Zang-Fu Theory. Forty-five (45) adults with mild hypercholesterolemia but who were otherwise healthy participated in the study. Results: Our results suggest that there is a reasonably good level of agreement between at least two practitioners on the dimensions of the Eight Guiding Principles. Level of agreement between at least two practitioners on CM syndrome diagnosis according to Zang-Fu Theory was very good for one syndrome only, that of Spleen qi deficiency. Conclusions: Further investigations are needed into the reliability of the CM diagnostic processes from the initial stage of data collection to the final CM syndrome diagnosis. [ABSTRACT FROM AUTHOR]