Moxibustion for treating patients with hyperlipidemia: A systematic review and meta-analysis protocol

BACKGROUND

Hyperlipidemia has been a root cause of atherosclerosis, which leads to a high risk to serious cardio-cerebrovascular disease. Many trials have reported that moxibustion therapy is effective in lowering blood lipid levels when treating hyperlipidemia. The aim of this systematic review is to assess the effectiveness and safety of moxibustion therapy for hyperlipidemia.

METHODS

Two reviewers will electronically search the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; China National Knowledge Infrastructure (CNKI); Chinese Biomedical Literature Database (CBM); Chinese Scientific Journal Database (VIP database); and Wan-Fang Database from the inception, without restriction of publication status and languages. Additional searching including researches in progress, the reference lists and the citation lists of identified publications. Study selection, data extraction, and assessment of study quality will be performed independently by 2 reviewers. Changes of blood lipid levels from baseline to the end of the treatment, including low-density lipoprotein cholesterol (LDL-C) level, total cholesterol (TC) level, triglycerides (TG) level and high-density lipoprotein cholesterol (HDL-C) level will be assessed as the primary outcomes. Quality of life, long-term effect and safety will be evaluated as secondary outcomes. If it is appropriate for a meta-analysis, RevMan 5.3 statistical software will be used; otherwise, a descriptive analysis will be conducted. Data will be synthesized by either the fixed-effects or random-effects model according to a heterogeneity test. The results will be presented as risk ratio (RR) with 95% confidence intervals (CIs) for dichotomous data and weight mean difference (WMD) or standard mean difference (SMD) 95% CIs for continuous data.

RESULTS

This study will provide a comprehensive review of the available evidence for the treatment of moxibustion with hyperlipidemia.

CONCLUSIONS

The conclusions of our study will provide an evidence to judge whether moxibustion is an effective and safe intervention for patients with hyperlipidemia.

ETHICS AND DISSEMINATION

This systematic review will be disseminated in a peer-reviewed journal or presented at relevant conferences. It is not necessary for a formal ethical approval because the data are not individualized.

TRIAL REGISTRATION NUMBER

PROSPERO CRD42019130545.

Medicated thread moxibustion for alopecia areata: A case report

RATIONALE

According to the literature reports and clinical studies on alopecia areata (AA) from 2008 to 2018, most clinical treatments have been oral drugs and external ointments. At present, systemic immunosuppressive therapy has been widely used in AA, but there are various side effects such as elevated liver enzymes, gastrointestinal discomfort, poor drug compliance, and repeated illness. We present a case report describing a traditional medicine treatment for AA that uses an ethnic therapy of Zhuang medicine, a kind of Traditional Chinese Medicine, namely, medicated thread moxibustion.

PATIENT CONCERNS

A 36-year-old man endured AA after going through a family misfortune. Half a year ago, his father passed away suddenly. Since then, he suffered continuous anguish, alcoholism and hair loss, especially in the past 2 months. A coin-shaped area of hair loss began to appear at the top of his head and gradually expanded to the surrounding region.

DIAGNOSES

A diagnosis of AA was made in the dermatology department of a local hospital.

INTERVENTIONS

The patient was treated with the medicated thread moxibustion method of Traditional Zhuang Medicine at the Kuihua (special points of Zhuang medicine), Zusanli (ST 36), Xuehai (SP 10), Baihui (DU 20), and Taichong (LR 3) points every other day for 4 weeks.

OUTCOMES

The area of hair loss showed slight improvement after 1 week of treatment. Only just a sprinkling of wooly hairs, whose color and thickness were similar to those of fine facial hairs, began to emerge sporadically from the follicles; they could be seen only in a bright light. When the patient saw the obvious curative effect, we continued the treatment for 2 weeks with the patient's consent. Three weeks later, the patchy AA area was covered with small cotton-like hairs of different lengths and uneven colors.

LESSONS

The medicated thread moxibustion method of Zhuang medicine can be an effective alternative treatment in patients with AA.

Korean medicines for poor ovarian reserve in infertility: A protocol for a multicenter observational study

INTRODUCTION

Many infertile patients have used Korean medicines (KMs) as a primary or adjuvant therapeutic method to improve in vitro fertilization success rates. The aim of this multicenter observational study is to investigate the effects of KMs on poor ovarian reserve (POR) in infertile patients.

METHODS AND ANALYSIS

We will perform a prospective multicenter observational study. This study will recruit 50 women between 25 and 44 years of age with infertility caused by POR from among patients who visit the KM clinic. All participants will visit the KM clinic on the 2nd or 3rd day of menstruation to receive the KMs. KM treatment will be delivered for 3 menstrual cycles (3 months) and will include herbal decoction, acupuncture, or moxibustion on demand. Every participant will be assessed based on KM clinical symptoms, a quality of life questionnaire, and ovarian reserve test results.

ETHICS AND DISSEMINATION

The study was approved by Institutional Review Board of Semyung University (SMU-IM-190501). The results will be published in a peer-reviewed journal and will be disseminated electronically and in print.

TRIAL REGISTRATION NUMBER

Clinical Research Information Service: KCT0004209.

The efficacy and safety of moxibustion for primary dysmenorrhea: A systematic review protocol

BACKGROUND

Primary dysmenorrhea (PDM) is one of the most prevalent gynecological diseases in women of childbearing age. The major medications treating PDM usually make sense and side effects, while moxibustion is known as a safe and effective treatment for PDM. This review aims to systematically evaluate the effect and safety of moxibustion for treating PDM.

METHODS

We will search all randomized controlled trials for moxibustion therapy on PDM, electronically and manually, regardless of publication status, till October 31, 2019. Online databases include the Cochrane Central Register of Controlled Trials; PubMed; EMBASE; China National Knowledge Infrastructure; Chinese Biomedical Literature Database; Chinese Scientific Journal Database (VIP database); and Wan-Fang Database. Two reviewers will search these databases, select data and measure the quality of studies independently. The methodological quality will be assessed by the Cochrane Reviewer's Handbook 6.0. The primary outcomes include clinical efficacy and visual analog scale, and the secondary outcomes include adverse events and quality of life. Four reviewers will independently extract the data and assess the qualities of the studies. Statistical analysis will be conducted with R package for each outcome. Study selection, data extraction, and assessment of risk of bias will be performed independently by 2 reviewers.

RESULTS

This study will provide a comprehensive review of the available evidence for the treatment of moxibustion with PDM.

CONCLUSION

The conclusion of our study will provide updated evidence to judge whether moxibustion is an effective and safe intervention for patients with PDM.

PROSPERO REGISTRATION NUMBER

CRD42019129993.

Effectiveness and safety of moxibustion in treatment of lumbar disc herniation: a systematic review and Meta-analysis

OBJECTIVE

To evaluate the effectiveness and safety of moxibustion therapy in the treatment of lumbar disc herniation (LDH).

METHODS

Four Chinese databases and three English databases were searched from their inception to April 2018.Randomized controlled trials (RCTs) were included if moxibustion was used as the sole treatment or as a part of combination therapy with other treatments in patients with LDH. Two reviewers independently extracted the data and assessed the methodological quality using the Cochrane criteria for the risk of bias. The Meta-analysis was performed using Review Manager 5.3 software.

RESULTS

In total, 16 RCTs including 1186 patients with LDH were analyzed. The Meta-analysis showed favorable effects of moxibustion in combination with massage therapy on the visual analog scale score compared with massage therapy alone [mean difference (MD) = -1.32, 95% confidence interval (CI) (-2.12, -0.51), P = 0.001]. The subgroup Meta-analysis failed to show favorable effects of electro-acupuncture plus moxibustion on the efficacy rate compared with electro-acupuncture alone [relative risk (RR) = 1.06, 95% CI (0.98, 1.14), P = 0.15]. However, acupuncture or massage therapy plus moxibustion improved the efficacy rates compared with acupuncture or massage therapy alone [RR = 1.33, 95% CI (1.18, 1.49), P < 0.000 01] [χ2 = 2.76, P = 0.25, I2 = 27%], [RR = 1.15, 95% CI (1.06, 1.25), P = 0.001] [χ2 = 0.00, P = 0.95, I2 = 0%]. With respect to the Japanese Orthopaedic Association (JOA) scores, acupuncture or massage therapy in addition to moxibustion produced results different from those of acupuncture or massage therapy alone [MD = 5.58, 95% CI (4.15, 7.00), P < 0.000 01] [χ2 = 0.58, P = 0.45, I2 = 0%], [MD = 3.61, 95% CI (3.01, 4.21), P < 0.000 01].There were no significant differences in the JOA score for subjective symptoms, objective symptoms, daily living ability, and other parameters. In six RCTs, no adverse reactions occurred during moxibustion.

CONCLUSION

Whether moxibustion is an effective intervention for LDH is unclear because of the small sample size of qualified RCTs and the high risk of bias. More high-quality RCTs that overcome the methodological shortcomings of the existing evidence are needed.

[Construction of the student-centered classroom teaching practice of Acupuncture Moxibustion Teaching Practice at the background of "Internet Plus"]

Acupuncture Moxibustion Teaching Practice is the course of strong operation skills in science of acupuncture and moxibustion. In classroom teaching, on the basis of "Internet Plus", a "student centered" teaching idea was constructed. The "Internet Plus" education information technology was used rationally, the self-learning ability and explorative learning were guided. In teaching, the "We Media" resource construction, learning assessment and achievement sharing were carried out to ensure the active participation of teachers in teaching reform, encourage students to learn initiatively and improve the teaching quality.

Effect of mild moxibustion on intestinal microbiota and NLRP6 inflammasome signaling in rats with post-inflammatory irritable bowel syndrome

BACKGROUND

About one-third of refractory irritable bowel syndrome (IBS) cases are caused by gastrointestinal (GI) infection/inflammation, known as post-infectious/post-inflammatory IBS (PI-IBS). Although it is known that intestinal microbiota and host NOD-like receptor family pyrin domain containing 6 (NLRP6) inflammsome signaling are closely related to PI-IBS and moxibustion has a therapeutic effect on PI-IBS, whether moxibustion regulates the intestinal flora and host NLRP6 events in PI-IBS remains unclear.

AIM

To examine the regulatory effect of moxibustion on intestinal microbiota and host NLRP6 inflammatory signaling in PI-IBS.

METHODS

Sprague-Dawley rats were divided into a normal control group, a model control group, a mild moxibustion group, and a sham mild moxibustion group. PI-IBS rats in the mild moxibustion group were treated with moxibusiton at bilateral Tianshu (ST 25) and Zusanli (ST36) for 7 consecutive days for 10 min each time. The sham group rats were given the same treatment as the mild moxibustion group except the moxa stick was not ignited. Abdominal withdrawal reflex (AWR) score was measured to assess the visceral sensitivity, and colon histopathology and ultrastructure, colonic myeloperoxidase (MPO) activity, and serum C-reactive protein (CRP) level were measured to evaluate low-grade colonic inflammation in rats. The relative abundance of selected intestinal bacteria in rat feces was detected by 16S rDNA PCR and the NLRP6 inflammsome signaling in the colon was detected by immunofluorescence, qRT-PCR, and Western blot.

RESULTS

The AWR score was significantly decreased and the low-grade intestinal inflammation reflected by serum CRP and colonic MPO levels was inhibited in the mild moxibustion group compared with the sham group. Mild moxibustion remarkably increased the relative DNA abundances of Lactobacillus, Bifidobacterium, and Faecalibacterium prausnitzii but decreased that of Escherichia coli in the gut of PI-IBS rats. Additionally, mild moxibustion induced mRNA and protein expression of intestine lectin 1 but inhibited the expression of IL-1β, IL-18, and resistance-like molecule β by promoting the NLRP6 and reducing the mRNA and protein expression of apoptosis-associated speck-like protein containing CARD (ASC) and cysteinyl-aspartate-specific proteinase 1 (Caspase-1). The relative DNA abundances of Lactobacillus, Bifidobacteria, Faecalibacterium prausnitzii, and Escherichia coli in each group were correlated with the mRNA and protein expression of NLRP6, ASC, and Caspase-1 in the colon.

CONCLUSION

These findings indicated that mild moxibustion can relieve low-grade GI inflammation and alleviate visceral hypersensitivity in PI-IBS by regulating intestinal microbes and controlling NLRP6 inflammasome signaling.

Treatment of postpill amenorrhea with abdominal obesity by traditional Korean medicine treatment focused on pharmacopuncture and moxibustion: A case report

RATIONALE

Hormone imbalance and menstrual irregularities are normal for postpill women. Pharmacopuncture and moxibustion can stimulate acupoints with herbal extract and heat, respectively, to regulate the function of qi and blood, expel pathogens, and support health.

PATIENT CONCERNS

A 39-year-old female patient presented with amenorrhea, >6 months after she had stopped taking the oral contraceptive pill, which she had taken for more than 10 years, and possible associated infertility. Additionally, she reported sudden weight gain of approximately 12 kg in 1 year.

DIAGNOSES

In this study, we examined the amenorrhea lasted more than 6 months for postpill patient.

INTERVENTIONS

She refused a strong acupuncture stimulus; she underwent lower abdomen pharmacopuncture with wild ginseng complex (WGC) and moxibustion at CV4, 5 times during 1 month. As a secondary treatment, 1 g Geoseub-hwan pills were prescribed for overeating and during social events. After 5 weekly primary treatments, Geoseub-hwan was prescribed intermittently.

OUTCOME

After 3 primary treatments, she began menstruation without menstrual cramps or discomfort. After 5 treatments, she exhibited improvement of body weight and body composition. At 1- and 3-month follow-up examinations, she confirmed regular menstruation without discomfort.

LESSONS

Pharmacopuncture with WGC and moxibustion may be effective for the treatment of postpill amenorrhea with abdominal obesity and can be used for patients with fear of a strong acupuncture stimulus.

The effectiveness of moxibustion for stable angina pectoris: A meta-analysis and trial sequential analysis protocol

BACKGROUDS

Moxibusion is a famous traditional Chinese medicine (TCM) treatment, which can be used to treat stable angina pectoris for many years. We will conduct this study to explore the efficacy and safety of moxibustion as an additional therapy and to provide more reliable evidence for clinical practice.

METHODS

We will go through 8 databases until July 2019 to identify related randomized controlled trials that compared moxibustion with the control group. The main result is the clinical effective rate. RevMan (V.5.3) and test sequential analysis (V.0.9) will be used for mata analysis and trial sequential analysis.

RESULTS

This study will provide a high-quality synthesis of current evidence of moxibustion and we have a specific opportunity to determine the efficacy and safety of moxibustion in patients with stable angina pectoris.

CONCLUSIONS

This study will explore whether or not moxibustion can be used as one of the non-drug therapies to prevent or treat stable angina pectoris, especially in the elderly population with related risk factors.

REGISTRATION NUMBER

CRD42018112830.

Effects of infrared laser moxibustion on cancer-related fatigue in breast cancer survivors: Study protocol for a randomized controlled trial

BACKGROUND

Cancer-related fatigue (CRF) is the most common and distressing symptom associated with cancer treatment that breast cancer survivors (BCS) experience. We previously found that laser moxibustion may be efficacious for CRF. The primary aim of this study is to determine the specific efficacy of 10.6 μm infrared laser moxibustion on CRF. The secondary aim is to evaluate the effect of infrared laser moxibustion on co-existing symptoms that BCS experience.

METHODS

We will conduct a randomized, sham-controlled, three-arm trial of infrared laser moxibustion (ILM) against sham ILM (SILM) and waitlist control (WLC) among BCS with moderate to severe fatigue. The two intervention groups will receive either real or sham infrared laser moxibustion on four acupoints (i.e., ST36 [bilateral], CV4, and CV6) for 20 minutes each session for 6 weeks (twice per week). The primary endpoint is the change in fatigue score from Baseline to Week 6 as measured by the Chinese version of the Brief Fatigue Inventory (BFI-C). Our secondary aim is to compare the severity of co-morbidities (e.g., depression, insomnia, and pain) among the 3 groups.

DISCUSSION

The results of our trial will establish evidence for the efficacy of infrared laser moxibustion for CRF, a very common and challenging symptom.

TRIAL REGISTRATION NUMBER

NCT03553355.

Efficacy and safety of electric heating moxibustion for perennial allergic rhinitis: protocol for a randomized controlled trial

BACKGROUND

Allergic rhinitis (AR) is an IgE-mediated disease that adversely affects quality of life. Many studies report that moxibustion is an effective treatment for perennial allergic rhinitis (PAR). However, it is difficult to perform moxibustion on the face because of possible burning of the skin and the noxious effects of smoke. Electric heating moxibustion does not have these limitations. The purpose of this clinical trial is to assess the possibility of treating PAR with electric heating moxibustion and to assess the feasibility of conducting a clinical test on a larger scale.

METHODS

This is a randomized, open-label, assessor-blind, parallel-design pilot clinical study. We will recruit 40 eligible participants and randomly allocate them into an electric heating moxibustion group or an acupuncture group at a 1:1 ratio. Patients in both groups will receive eight treatments over 4 weeks, and the final follow-up will be 4 weeks after the last treatment. Eleven acupuncture points will be used for patients in both groups (EX-HN3 and bilateral EX-HN-8, LI20, LI4, GB20, and ST36). The primary outcome measure is change in the Total Nasal Symptom Score, and the secondary outcome measures are changes in the Rhinoconjunctivitis Quality of Life Questionnaire, nasal endoscopy index for pattern identification, pattern identification questionnaire for AR, total IgE, eosinophil count, and adverse effects.

DISCUSSION

This clinical trial will examine the effect of electric heating moxibustion on PAR.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT03342105 . Registered on 14 November 2017.

Effects of moxibustion on pain behaviors in patients with rheumatoid arthritis: A meta-analysis

BACKGROUND

Pain is the main symptom of patients with rheumatoid arthritis (RA). Reports of the effects of moxibustion on patients with rheumatoid arthritis have reached various conclusions. The aim of this meta-analysis was to evaluate the effect of moxibustion on pain in patients with RA.

METHODS

A systematic search of MEDLINE, EMBASE, the Cochrane Library, and the Chinese databases Wan Fang Med Database, CNKI, and VIP (until November, 2018) was used to identify studies reporting pain (on a visual analogue scale (VAS)), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and rheumatoid factor (RF) levels, response rate, and the ACR50 rate in patients with RA. Results were expressed as mean difference (MD) and 95% confidence intervals (CI).

RESULTS

Six studies involving 281 participants were included. Moxibustion had significant effects on pain (VAS: MD = -0.53, 95% CI [-0.94, -0.12], P =.01). Moreover, moxibustion had effects on CRP (MD = -2.84, 95% CI [-5.13, -0.55], P =.01), ESR (MD = -8.44, 95% CI ([-13.19, -3.68], P =.0005), and RF (MD = -6.39, 95% CI [-18.57, 5.79], P =.30). Additionally, it had effects on response rate (n = 249, RR = 1.26, 95% CI [1.11, 1.43], P =.0004) and ACR50 rate (n = 140, RR = 1.44, 95% CI [1.11, 1.88], P =.007).

CONCLUSION

We found that moxibustion with Western medicine therapy is superior to Western medicine therapy alone for pain in patients with RA. Moxibustion had significant effects on pain in patients with RA, but the effects of moxibustion on inflammatory factors in RA were unclear.

Moxibustion for rheumatoid arthritis: Protocol for a systematic review

BACKGROUND

Rheumatoid Arthritis (RA) is a serious chronic disease which will result in serious syndrome such as joints stiffness, disability, and death. The major medications treating RA usually make sense and side effects, while moxibustion is known as a safe and effective treatment for RA. This review aims to systematically evaluate the effect and safety of moxibustion for treating RA.

METHODS

The following databases will be searched from their inception to March 2019: PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, Wan-Fang Databases, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), Citation Information by National Institute of Informatics, Chinese Scientific Journal Database (VIP Database). Two reviewers will search these databases, select data and measure the quality of studies independently. The methodological quality will be assessed by the Cochrane risk of bias tool. Data will be synthesized by either the fixed-effects or random-effects model according to a heterogeneity test. The primary outcome is symptom evaluation including morning stiffness, pain and joint swelling. The number of joints affected by RA, adverse effects, quality of life, erythrocyte sedimentation rate (ESR), C reactive protein (CRP), and Rheumatoid factor (RF) will be evaluated as secondary outcomes. Risk ratio for dichotomous data and mean differences with a 95% confidence interval for continuous data will be adopted to express the effect and safety of acupuncture for RA.

RESULTS

This study will provide a high-quality synthesis of current evidence of moxibustion for asthma from several aspects including morning stiffness, pain and joint swelling. The number of joints affected by RA, adverse effects, quality of life, erythrocyte sedimentation rate (ESR), C reactive protein (CRP), and Rheumatoid factor (RF).

CONCLUSION

The conclusion of our study will provide updated evidence to judge whether moxibustion is an effective and safe intervention for patients with RA.

ETHICS AND DISSEMINATION

As individuals will not be involved, the ethical approval will not be required. This review will be published in a peer-reviewed journal or at a relevant conference.

PROSPERO REGISTRATION NUMBER

CRD42019126685.

Effect of herb-partitioned moxibustion on dopamine levels and dopamine receptor 1 expression in the colon and central nervous system in rats with Crohn's disease

OBJECTIVE

To observe the effect of herb-partitioned moxibustion at the Tianshu (ST 25) and Qihai (CV 6) acupoints in rats with Crohn's disease, and explore the underlying mechanism from dopamine (DA) and dopamine receptor 1 (D1R) in the colon, spinal dorsal horn and hypothalamus.

METHODS

The rats were randomly divided into the normal, model (CD), herb-partitioned moxibustion (Mox) and mesalazine (Mesa) groups. Damage in the colons was scored and observed by hematoxylin and eosin staining. DA and D1R protein expression in the colonic mucosa were detected by immunohistochemistry. The concentrations of DA and D1R in the spinal dorsal horn and hypothalamus were measured by enzyme-linked immunosorbent assay, and D1R mRNA expression was evaluated by quantitative real-time polymerase chain reaction.

RESULTS

In the colon, compared with the normal group, DA, D1R protein expressions and D1R mRNA expression were significantly higher in the model group, while decreased in the Mox group and the Mesa group. In the spinal dorsal horn and hypothalamus, compared with the normal group, the concentrations of DA and D1R, and the D1R mRNA expressions were significantly higher in the model group, and decreased in the Mox group and the Mesa group.

CONCLUSION

Herb-partitioned moxibustion at the Tianshu (ST 25) and Qihai (CV 6) acupoints relieved ulceration in CD rats, the underlying mechanism maybe relative with the regulation of DA and D1R in the colon, spinal dorsal horn and hypothalamus by moxibustion.

Efficacy and safety of moxibustion in patients with chronic prostatitis/chronic pelvic pain syndrome: A systematic review protocol

BACKGROUND

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common urogenital disease. Moxibustion is a complementary treatment option for CP/CPPS. This systematic review will assess the efficacy and safety of moxibustion as a sole or add-on therapy for CP/CPPS.

METHODS

We will retrieve randomized controlled trials (RCTs) of moxibustion for CP/CPPS from the following databases: PubMed, EMBASE, Cochrane Central Register of Controlled Trials, VIP, Chinese Biomedical Database, China National Knowledge Infrastructure Database, Wanfang Data, Chinese Medicine Database System, Google Scholar, Clinicaltrials.gov, and China Clinical Trial Registry from their inception to March 9, 2019, without language restrictions. RCTs comparing moxibustion with active drugs or moxibustion + drugs with these same drugs alone will be included. Primary outcomes will be the change in the total score of the National Institutes of Health's Chronic Prostatic Inflammatory States Index (NIH-CPSI) after moxibustion treatment. Secondary outcomes will include the scores of the individual NIH-CPSI domains, response to treatment of CP/CPPS, leucocyte and phosphatidylcholine corpuscle count in prostatic fluid, incidence of adverse events (AEs), and incidence of moxibustion-related AEs. The Cochrane risk of bias tool will be used for evaluating the risk of bias of individual trials. Heterogeneity will be detected by the Cochran Q test and I-square test. A random-effects model will be used to pool data in the meta-analysis. Risk ratio and weighted or standardized mean difference will be used as the effect measures. Three sets of subgroup analyses will be performed to explore the sources of heterogeneity. Where appropriate, we will assess the likelihood of publication bias based on funnel plots and quantitative tests.

RESULTS

This study will produce the systematic review evidence regarding moxibustion for treating CP/CPPS based on current RCTs.

CONCLUSION

This study will provide a clear basis for understanding the efficacy and adverse reactions of moxibustion treatment for CP/CPPS.

PROSPERO REGISTRATION NUMBER

CRD42019121338.

Efficacy and safety of grain moxibustion in hemiplegia: A systematic review and meta-analysis protocol

BACKGROUND

The increasing morbidity of stroke brings enormous social and economic pressure to the countries. Hemiplegia is the common sequela of stroke patients, which affects their physical activities and daily life, and its optimal treatment is still an urgent problem. In Asian countries, moxibustion therapy is widely combined with rehabilitation in poststroke hemiplegia. Among them, grain moxibustion, due to its concentration on stimulating the acupoints and deep heat penetration, can promote neurorehabilitation after stroke. Therefore, based on the current literatures, the effectiveness and safety of grain moxibustion were systematically evaluated to provide possible alternative therapy for the rehabilitation of hemiplegia.

METHODS

Studies search for eligible randomized controlled trials (RCTs) that use grain moxibustion as the sole treatment for hemiplegia and their data extraction will be done by two researchers. Mean difference (MD) or relative risk (RR) with fixed or random effect model in terms of 95% confidence interval (CI) will be adopted for the data synthesis. To evaluate the risk of bias, the Cochrane's risk of bias assessment tool will be utilized. The sensitivity or subgroup analysis will also be conducted when meeting high heterogeneity (I > 50%).

RESULTS

This meta-analysis will provide an authentic synthesis of the grain moxibustion's effect for hemiplegia.

CONCLUSION

The findings of the review offer updated evidence and identify whether grain moxibustion can be an effective treatment for hemiplegia.

PROSPERO REGISTRATION NUMBER

PROSPERO CRD 42018117765.

Effectiveness and safety of warm needle acupuncture on children with cerebral palsy: Protocol for a systematic review and meta-analysis

BACKGROUND

Warm needle acupuncture (WNA) is an integral part of the acupuncture therapy, which combines acupuncture and moxibustion. Children with cerebral palsy (CP) is a common disease in children, which seriously affects children's growing development, physical and mental health. The clinical practice indicates that WNA has a therapeutic effect on children with CP. Here we will provide a protocol to explore the effectiveness and safety of WNA for children with CP.

METHODS

We will search the randomized controlled trails (RCT) literatures of WNA for children with CP in 5 English databases [PubMed, Web of Science, EMBASE, the Cochrane Central Register of Controlled Trials (Cochrane Library), and WHO International Clinical Trials Registry Platform (ICTRP)] and 4 Chinese databases [Chinese National Knowledge Infrastructure (CNKI), Chinese VIP Information, Wanfang Database, and Chinese Biomedical Literature Database (CBM)]. Activity of Daily Living Scales (ADL) of the patient will be considered as the primary outcome and the secondary outcome will include 88 items of gross motor function scale (GMFM-88), Gesell Growth Table (GGT), Criteria for judging efficacy and adverse events caused by WNA such as dizziness, nausea, vomiting, weariness, etc. The selection of the studies will be performed by EndnoteX7 software. And we will conduct all analyses with RevMan software V5.3.

RESULT

This study will provide a rational synthesis of current evidences for WNA on children with CP.

CONCLUSION

The conclusion of this study will provide evidence to judge the effectiveness and safety of WNA on children with CP.

REGISTRATION

PROS-PERO CRD42019122034.

Effectiveness and safety of fire-needle moxibustion on insomnia: Protocol for a systematic review and meta-analysis

BACKGROUND

Fire-needle moxibustion (FNM) is an ancient method of external therapy that combines acupuncture with moxibustion, and has the property of high temperature resistance. Insomnia is a major public health problem and strongly associated with a high prevalence, impact on daily life, comorbidity with other disorders, and societal costs. The clinical practice demonstrates that FNM has a therapeutic effect on insomnia. Here we will provide a protocol to evaluate the effectiveness and safety of FNM for insomnia.

METHODS

We will search the randomized controlled trial literatures of FNM for insomnia in 7 electronic databases, including 3 English databases (PubMed, EMBASE, the Cochrane Central Register of Controlled Trials [Cochrane Library]) and 4 Chinese databases (Chinese National Knowledge Infrastructure, Chinese VIP Information, Wanfang Database, and Chinese Biomedical Literature Database). Pittsburgh Sleep Quality Index will be considered as the primary outcome, and the secondary outcome will include biochemical, indicators total scores on the insomnia severity index, quality of life, adverse events caused by FNM, and changes of TCM syndromes scores. Review Manager 5.2 software will be use for assessment of risk of bias, data synthesis. Begg and Egger tests will be use for assessing symmetries of funnel plot by software Stata 12.0. Methodological quality will be assessed with the risk of bias according to Cochrane Handbook.

RESULT

This study will provide a rational synthesis of current evidences for Fire-needle moxibustion on insomnia.

CONCLUSION

The conclusion of this study will provide evidence to judge the effectiveness and safety of Fire-needle moxibustion on insomnia.

REGISTRATION

PROS-PERO CRD42019120875.

Efficacy and safety of electroacupuncture in treatment of lumbar disc herniation: a protocol for a cohort study

OBJECTIVE

To compare the efficacy of electroacupuncture (deep needling) and general orthopedics in treatment of lumbar disc herniation (LDH), and to evaluate its long-term efficacy.

METHODS

This trial is a prospective cohort study. A total of 175 participants will be observed. The exposure group is obtained from department of acupuncture and moxibustion and the control group is from orthopedic department in hospital. Patients in exposed group will receive electroacupuncture in Dachangshu (BL 25), Guanyuanshu (BL 26), L4 Jiaji points (EX-B2 L4), L5 Jiaji points (EX-B2 L5) and S1 Jiaji points (EX-B2 S1) in the affected side once a day, 6 times as a treatment course for two courses (12 times). Patients in control group will receive orthopedic conventional therapy. In acute period, the treatment is mannitol injection (250 mL∶50 g) 200 mL, i.v., q.d.; 0.9% sodium chloride injection 250 mL, vitamin C injection 2 g, Dexamethasone sodium phosphate injection 10 mg, i.v., q.d.; sterile water for injection 2 mL, adenosine cobalt amine injection 1 mg, i.m., q.d., 12 d. In remission period, the treatment is Voltaren (Diclofenac diethyl lamine emulsion) external, q.d., 12 d. The researchers do not give any other intervention and record the relevant information only.

RESULTS

Modified Japanese Orthopaedic Association Scores, Visual Analogue Scale/Score, the Short Form-36 Quality-of-Life Questionnaire and Oswestry Disability Questionnaire and the second outcome measures (Adverse Event Questionnaire and Relapse Questionnaire) are measured before treatment, after the sixth treatment, and after the twelfth treatment. The follow-up periods are 3 months after the twelfth treatment, 6 months after the twelfth treatment, 1 year after the twelfth treatment.

CONCLUSION

This study will provide clinical researchers with the evidence on the safety and long-term efficacy of electroacupuncture in patients with Lumbar disc herniation.

Acupuncture methods put to the test for a tinnitus study: A Bayesian analysis

BACKGROUND

This study evaluated the effectiveness of different methods of acupuncture in the treatment of tinnitus due to neurological causes. In total, eight treatment methods were selected for this study: traditional acupuncture, electroacupuncture, moxibustion acupuncture, medicine only without acupuncture, traditional acupuncture with supplementary medicine, electroacupuncture with supplementary medicine, moxibustion acupuncture with supplementary medicine, and an electroacupuncture and moxibustion acupuncture combination. All sample data come from the results of clinical treatment studies.

METHODS

Both Chinese- and English-language online databases were searched. The Chinese language databases included the Wanfang database, the China National Knowledge Infrastructure (CNKI) database, and the VIP Chinese Science and Technique Journals database. The English language databases included PubMed, Web of Science, Embase and Cochrane Library. After the previously mentioned eight interventions for the treatment of neurological tinnitus were tested in a randomized controlled trial (RCT), the data were extracted, and the effectiveness of each intervention was evaluated. A meta-analysis was performed using Stata14.0 and GeMTC 0.14.3 statistical software.

RESULTS

A total of 40 studies were included, which contained a total of 3657 patients and 8 intervention methods. There was a trend of greater effectiveness of moxibustion acupuncture, followed by moxibustion acupuncture combined with electroacupuncture, moxibustion acupuncture combined with supplementary medicine, acupuncture combined with drugs, electroacupuncture with supplementary medicine, electroacupuncture, traditional acupuncture, and medicine only without acupuncture. There was no significant difference between the results of indirect comparisons and direct comparisons.

CONCLUSIONS

Eight interventions are all effective in the treatment of neurological tinnitus, but moxibustion acupuncture seems to be a better trend treatment for tinnitus.

Moxibustion as a Therapy for Breast Cancer-Related Lymphedema in Female Adults: A Preliminary Randomized Controlled Trial

Objective: To evaluate the effect of moxibustion on relieving breast cancer-related lymphedema. Materials and Methods: A randomized controlled trial was conducted in our institution from March 2016 to March 2017. All patients (N = 48) with cancer-related lymphedema were allocated to 2 groups: a treatment group, in which moxibustion was performed, and a control group, in which pneumatic circulation was performed with compression garments worn every day. Therapeutic efficacy was evaluated by measuring arm circumference (wrist crease, 10 cm proximal to wrist crease, elbow crease, and 10 cm proximal to elbow crease) and determining the Revised Piper Fatigue Scale score and Visual Analog Scale score for swelling before and after treatment. Results: All patients were treated for 4 consecutive weeks. Compared with 0 week after treatment, the affected-side arm circumference after 4 weeks' treatment decreased in both treatment and control groups; the difference value in the treatment group was superior to that in the control group. Compared with the controls, moxibustion resulted in a lower Visual Analog Scale score. The Revised Piper Fatigue total scores were improved in both the moxibustion and control group, and there was no significant difference between the 2 groups. Moxibustion reduced the behavioral, sensory, emotional, and cognitive Revised Piper Fatigue scores, but only the behavioral and sensory scores improved in the control group. Conclusion: Moxibustion has potential effect on breast cancer-related lymphedema. We present promising preliminary data for larger randomized trials to enable accurate evaluation of moxibustion as a lymphedema treatment.

Effectiveness and safety of warm needle acupuncture on insomnia: Protocol for a systematic review and meta-analysis

BACKGROUND

Warm needle acupuncture (WNA) combines acupuncture and moxibustion, which is an integral part of the acupuncture therapy. Insomnia is a common sleep disorder, which affects sub-healthy people and patients with chronic disease. The clinical practice indicates that WNA has a therapeutic effect on insomnia. Here we will provide a protocol to explore the effectiveness and safety of WNA for insomnia.

METHODS

We will search the randomized controlled trails (RCT) literatures of WNA for insomnia in 9 electronic databases, including 5 English databases [PubMed, Web of Science, EMBASE, the Cochrane Central Register of Controlled Trials (Cochrane Library), and WHO International Clinical Trials Registry Platform (TCTRP)] and 4 Chinese databases [Chinese National Knowledge Infrastructure (CNKI), Chinese VIP Information, Wanfang Database, and Chinese Biomedical Literature Database (CBM)]. Sleep quality value of the patient will be considered as the primary outcome and the secondary outcome will include biochemical, indicators total scores on the insomnia severity index, quality of life, adverse events caused by WNA, and changes of symptom in Traditional Chinese Medicine. The selection of the studies will be performed by EndnoteX7 software. All analyses will be conducted by using RevMan software V5.3.

RESULT

This study will provide a rational synthesis of current evidences for warm needle acupuncture on insomnia.

CONCLUSION

The conclusion of this study will provide evidence to judge the effectiveness and safety of WNA on insomnia.

REGISTRATION

PROS-PERO CRD42018112645.

Herb-partitioned moxibustion alleviates colon injuries in ulcerative colitis rats

AIM

To observe the effect of herb-partitioned moxibustion (HPM) on expression of colonic cytokines in ulcerative colitis (UC) rats.

METHODS

A UC rat model was established by protein immunization in combination with topical chemical stimulation. Rats in the HPM group (n = 8) received HPM at bilateral Tianshu (ST25) points. The gross injury and pathological scores of the colon were recorded. The expression profile of colonic cytokines was assayed using the protein microarray technique. Specific differential cytokines were selected and verified by ELISA. The corresponding UniProt Accessions of the differentially expressed cytokines were retrieved in the UniProt database. The pathways involved were analyzed with the help of the KEGG PATHWAY database. The DAVID database was used for functional cluster and pathway analysis.

RESULTS

HPM improved colon injuries in UC rats, manifested by accelerated repair of ulcers and alleviation of inflammation, and the gross injury and pathological scores both significantly decreased (P < 0.01). Fold change > 1.3 or < 0.77 was taken as the screening standard. There were 77 down-regulated and 9 up-regulated differentially expressed colonic cytokines in the HPM group compared with the model group, and expression of 20 differed significantly (P < 0.05). Twelve of the 20 significantly differentially expressed cytokines [β-catenin, interleukin-1 receptor 6 (IL-1R6), IL-1β, B7-1, nerve growth factor receptor, AMP-activated protein kinase-α1, neuropilin-2, orexin A, adipocyte differentiation-related protein, IL-2, Fas and FasL] were up-regulated in the model group (n = 3, compared with the normal group) but down-regulated in the HPM group (n = 3, compared with the model group). Functional cluster analysis showed that the differentially expressed colonic cytokines in the HPM group regulated apoptosis and protein phosphorylation. KEGG pathway analysis showed that 52 down-regulated and 7 up-regulated differentially expressed colonic cytokines in the HPM group had pathways. The pathways that interacted between the cytokines and their receptors accounted for the largest proportion (28 of the down-regulated and 5 of the up-regulated cytokines).

CONCLUSION

HPM promotes the repair of colon injuries in UC rats, which is related to the regulation of several abnormally expressed cytokines.

Effectiveness and safety of moxibustion for alleviating symptoms of overactive bladder: A prospective, randomized controlled, crossover-design, pilot study

BACKGROUND

This study aimed to evaluate trial feasibility and explore the potential efficacy and safety of moxibustion in the treatment of overactive bladder (OAB).

METHOD

A randomized, controlled, cross-over, assessor blinded design was used. This study was conducted in an outpatient department of a university hospital in Republic of Korea. The overall study period was 8 weeks. Participants were randomly allotted to either Group A or Group B. Group A participants underwent 8 to 12 sessions of moxibustion with behavioral training during the first 4 weeks, while the Group B participants received behavioral training only. Over the next 4 weeks, the treatment offered to the 2 groups was reversed (Group A participants received behavioral training only, while Group B participants underwent the moxibustion session with behavioral training). The OAB-validated 8-question awareness tool (OAB-V8), OAB symptom scores (OABSS), visual analog scale (VAS) for lower urinary tract symptoms, and frequency voiding chart were used to assess outcomes. For analysis, we used effect size, measured as Hedge's g, to present descriptive results indicating the actual difference between the groups.

RESULTS

Compared to that in Group B, the Hedge's g of OAB-V8 for the former 4 weeks in Group A was -0.248, that of OABSS was -1.531, and that of VAS was -0.713. During the latter 4 weeks, Group B showed similar effect with g = 0.465, 1.207, and 0.427 for OAB-V8, OABSS, and VAS, respectively, compared to Group A. The portion of nocturnal voiding volume decreased (g = -0965), the mean voiding volume increased (g = 0.690), and the voiding frequency decreased (g = -0.498) with moxibustion.

CONCLUSIONS

Moxibustion might be considered as an alternative for OAB. A full-sized randomized controlled trial may be feasible with minimal modification in outcome measures and comparator population.

OTHER INFORMATION

This clinical trial has been registered on clinicaltrials.gov (NCT02271607).

Moxibustion using different habitat moxa floss for moderate to severe primary knee osteoarthritis: study protocol for a three-armed randomized, double-blinded, sham-controlled trial

BACKGROUND

According to the traditional Chinese medicine theory, moxa floss is the best material for moxibustion; the effect of moxibustion is closely related to the habitats of moxa floss, among which Qichun County, Hubei Province, China, is considered as the genuine origin. However, this view has not been validated by clinical studies. Moxibustion has been proven effective in alleviating pain and improving physical function and quality of life for patients with knee osteoarthritis (KOA). This trial aims to determine whether the habitat of moxa floss contributes to the effect of moxibustion and to validate the effectiveness of moxibustion for KOA.

METHODS

This is a three-armed, randomized, double-blinded, sham-controlled trial. A total of 350 patients with moderate to severe primary KOA will be randomly allocated to groups A, B, or C with a 2:2:1 ratio. Moxa stick moxibustion using moxa floss from different habitats will be applied in two experimental groups: group A, moxa floss from the habitat of Qichun County, Hubei Province, China; and group B, moxa floss from the habitat of Nanyang County, Henan Province. Group C will use non-moxa floss for sham moxibustion as control. Patients will be treated for 20 min per session, for three sessions per week for 2 weeks, and followed up for 4 weeks. The primary outcome will be the change from baseline in the pain score of the Western Ontario and McMaster Osteoarthritis Index (WOMAC) at week 2. Secondary outcomes will include a change in the WOMAC pain score at week 6; the visual analogue scale for knee pain, the total WOMAC score, the WOMAC stiffness score, the WOMAC function score, the patient global assessment, and the responder criteria at weeks 2 and 6. Adverse events will be assessed throughout the study.

DISCUSSION

This trial will help to identify the effectiveness of moxibustion for KOA and whether the habitat of moxa floss contributes to the effect of moxibustion.

TRIAL REGISTRATION

Acupuncture-Moxibustion Clinical Trial Registry: AMCTR-IOR-16000007 . Registered on 29 February 2016.