今年5月底，在我完全不抱期待的情況下，收到了期刊出版社確定刊登的信，第一時間跟圈外的朋友分享好消息。以他很喜歡提出質疑然後開啟辯論的個性，第一句回覆是：「所以試驗結果如何？」
At the end of May this year, I received a letter from a journal publisher confirming that the article would be published, even though I had no expectations at all. I immediately shared the good news with a friend outside my professional circle. As he likes to raise questions and start debates, his first reply was: "How were the trial results?"
「我記得病人轉普通病房的天數縮短了？不，其實我不確定結果如何，因為我是 “blinded” 的，我在執行計劃的時候是不該知道病人分組和結果的。他開始寫的時候我也離職了。」我說。
“I think the main result is fewer delirium days in the treatment group. No, I’m not sure, because I should be ‘blinded’, they shouldn’t tell me the results during the study, and by the time he started writing the paper, I left the hospital.”
「原來如此。會不會像對岸很多那種研究設計充滿疑慮的論文啊？......但如果可以加速痊癒，那也是好事啦。」他試圖挽救場面。
“I see. Seems like how a lot of China does their TCM research…questionably. But faster healing…if true, is good.” He tried to save it.
「我不知道耶。就算結果顯示有正面影響，要放入臨床實行還很困難。我當時在做的時候其實有很多講不出來的難處，而且需要各部門的合作。老實說，我覺得『合作』是最困難的部分。」
“I don’t know, even if it does have some positive effect, it’s hard to integrate into clinical practice. It was not easy when I was doing it. And it needs collaboration between departments. The cooperation part is the hardest one.”
「中醫要做臨床試驗本來就很難吧？因為中醫的治療因人而異。我的意思是，比如說，對中醫來說並非所有糖尿病人都一樣。但結合西醫模式的中醫治療可能效果更好。」
“TCM is often hard to do clinical trials. Right? Since treatment is so individual. I mean, for instance, not all diabetes in TCM is the same thing. But TCM treatment with Western med paradigm probably works better.”
「沒錯，中醫的應用可大可小。像是在SICU，他們需要的是病人情況穩定到足以轉到普通病房，而不是在加護病房把病人治好。你可以用四到五個穴位為基本，再為每個病人加另外二到三個穴位呀。」
“Right. There is significant variability in how TCM is applied. Like, at that point, they just need the patient to be stable enough to move to the general ward. Not to cure them. You can make 4-5 acupoints as a basic and add another 2-3 for each patient.”
「你真的是個醫生。」他停了一陣子後說。
“You're a true doctor.” He said after a long pause.
我真分不清最後那句是不是諷刺，不過沒關係。參加這個試驗讓我知道，在外科加護病房執行針灸，以單次操作的速度和安全性來說，壓針都比傳統針灸還快又安全，比較不影響管路，可以使用到平常不方便留針的穴位。而且在加護病房的病人，通常肉都是咬不住針的 (或是細微的肌纖維不自主顫動會把針擠掉)，加上譫妄的時候仰臥起坐、手腳亂揮、頭晃來晃去摩擦枕頭，傳統針灸的針早就飛掉了，也很容易導致針扎事件，壓針就不用擔心這些。
I can't tell if the last sentence is sarcastic or not, but it doesn't matter. What I learned from participating in this trial is that when performing acupuncture in the surgical intensive care unit, using the press tack needles is faster and safer than traditional acupuncture in terms of time cost and safety of a single operation; it is less likely to affect the lines and can be used at acupoints that are usually inconvenient to leave acupuncture needles. In addition, the muscles of a weak person, such as patient in the intensive care unit, usually cannot firmly grip the needles (or the minor involuntary twitching of muscle fibres squeezes the needle out). And patients with delirium can do sit-ups (under restraint), wave their hands and legs, and rub on the pillow; the needles of traditional acupuncture often fly away, which can also easily cause needlestick injury. You don’t have to worry about these with the press tack needles.
這個試驗也更新了我對針刺深度對於療效的認知。壓針的針身長只有 0.6mm，雖然可以使用皮膚比較薄或是針感比較強的穴位，比如耳神門、印堂、湧泉，但是像三聖穴 (近湧泉的董氏奇穴)，有些病人的腳皮很厚而且腳也很冰，我實在不確定貼針到底有沒有刺激效果。
This trial also re-equipped my understanding of how acupuncture needle depth can influence treatment efficacy. The needle length of the press tack needles is only 0.6mm. Although it can be used on acupoints with thinner skin or sites that trigger stronger sensations, such as auricular point MA-TF1 (Shen Men), Yin Tang(EX-HN 3), and Yongquan(KI1), some patients have thick skin and cold feet and so when I was applying press tack on San Shang (an acupoint from the Tung-style system), I was hesitant about whether the acupuncture would have any effect.
這個試驗使用的穴位數，由於兩側對稱，加起來還是偏多。真的要納入臨床處置的話，如果能特定出3-5個必要穴位、不一定要對稱，而且不要選在手腳綁約束的位置 (例如內關、神門)，應該會更好操作。
There were still too many acupoints used in this trial, counting on both sides (symmetric acupoints). It should be easier to do with a basic set consisting of 3-5 acupoints, not necessarily symmetrical, and not in the position where they put medical restraints (such as HT 7 [Shen Men], PC 6 [Nei Guan]).
病人從譫妄穩定下來所需的時間，很大程度影響醫療資源和人力的消耗，在一些狀況下也可能會影響一個家庭會不會被醫療費用拖垮。用小小幾片壓針就能加速病人好轉，CP值很高不是嗎？所以我認為它還是一個很有潛力的輔助性醫療處置。
The timespan a patient needs to recover from delirium greatly affects the cost of medical resources and manpower. In the long run, this can also affect whether a family will be dragged down by the cost it takes. Using a few press tack needles can speed up the patient's healing. Isn't this sound worth it? I personally think it is still a very promising complementary treatment.
離開醫學中心2年了吧？在醫院工作的最後幾年，我們一起在外科加護病房合作過幾項臨床試驗。這麼多年過去了，他一直在努力寫論文，甚至把我列為作者之一，讓我沒有被消失，很感動。投稿、被退、再投稿，由於我持續都會收到期刊的信，因此知道曾經的工作夥伴仍持續不斷的努力著，讓我們的工作能被看見。
It has been two years since I left my job at the hospital centre. In the last years working there, we worked together on a few clinical trials in the surgical intensive care unit. Years passed, he has been working hard on the papers, and even included me as one of the authors. (It’s quite touching to me to know that they didn’t just wipe me out.) Submitting, being rejected, and submitting again, I have intermittently received letters from various journal publishers, so I knew that my former work partner is diligent in making our hard work recognised.
臨床試驗從一開始的寫計劃、通過IRB審查、收案、執行、維持資料品質，寫成論文到刊登發表，都是非常不容易的事。到現在還是會聽到隨便哪個人在講寫論文的事，就會誘發創傷反應。不過，參加晨會就是很多這種報告，所以其實也無法避開這些東西(´⌯ ̫⌯`)）。
期刊出版社表示為了鼓勵分享這篇作品，提供了一個限時連結，在 2025 年 7 月 23 日之前點擊此鏈接，即可直接跳轉至 ScienceDirect ，閱讀文章的最終版本，無需註冊或支付任何費用，歡迎大家免費閱讀或下載喔。𓈒𓂂 𓈒
https://authors.elsevier.com/c/1lCOv55vZHTg-
或用下面這連結
https://www.sciencedirect.com/science/article/pii/S0022395625003711
Clinical trials are not easy, from writing a protocol, getting IRB approval, managing case enrollment and teamwork, keeping data quality, to getting your results published. Even now, if I hear someone talking about writing a paper, it will trigger a traumatic reaction in me. Nevertheless, in morning meetings you have to listen to all of such stuff, so there is actually no way to avoid these things (´⌯ ̫⌯`)).
To encourage sharing of this work, the journal publisher has created a Share Link and provided 50 days' free access to the article. Anyone clicking on this link before July 23, 2025 will be taken directly to the final version of the article on ScienceDirect. You are welcome to read or download. No sign up, registration or fees are required.
https://authors.elsevier.com/c/1lCOv55vZHTg-
or use the alternative link:
https://www.sciencedirect.com/science/article/pii/S0022395625003711
𓈒𓍼
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